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COPYRIGHT DEPOSIT 






ANATOMY 
AND EMBALMING 



A Treatise on the Science and Art of Embalming, 

the Latest and Most Successful Methods 

of Treatment and the General 

Anatomy Relating to 

This Subject. 



BY 

ALBERT JOHN NUNNAMAKER, A. B. 

AND 

CHARLES O. DHONAU 

PROFESSORS OF ANATOMY AND SANITARY SCIENCE AT THE 
CINCINNATI COLLEGE OF EMBALMING, CINCINNATI, OHIO. 



Illustrated 



Cincinnati, Ohio. 
THE EMBALMING BOOK COMPANY. 
1913 






Copyright, 1913, by 
THE EMBALMING BOOK COMPANY. 



V 



JAN -2 1914 

CLA362369 



Dedicated 

TO 

Those Who Are Advancing 
The Standards 
of the 
Profession 



PREFACE 



This book is the result of many years of contact with 
embalmers in training and in practice. We have included 
in this work a crystallization of essential information 
without which, the embalmer must be poorly equipped to 
carry out the many duties incident to his calling in a 
manner satisfactory to his patrons and to himself. 

Having been thrown in contact with the many prob- 
lems surrounding the education of the embalmer, the 
authors have gained many ideas as to just how to place 
the information before the embalmer so that the result 
will be reflected in an increased capacity for good work 
on the part of the individual embalmer. 

In prescribing information for the embalmer in this 
manner, we know clearly just what is to be expected from 
the application of the sciences herein described, and wish 
for the novitiate and practitioner the same enthusiasm for 
actual knowledge that has helped us thus far in arranging 
the information. 

In Part One, we have chronicled, from the word of 
historians and men of the present day, a condensed, yet 
complete exposition of the funeral customs relating to the 



VI PREFACE 

care of the dead, giving our readers a better understand- 
ing of present methods by reason of an opportunity to 
compare them with those of the past. 

In Part Two, we have placed the ground work or 
foundation for the securing of the proper education in 
embalming. The work on Anatomy, which, if mastered 
by the student or practitioner, is by far the greatest lever 
in helping him to master his lif ework. 

In Part Three, we have placed the practical application 
of the principles of modern embalming, tempered by the 
use of the sciences of pathology, bacteriology, and chem- 
istry in our own application of the work and in its trans- 
cription to these pages. 

In formulating the technical part of the work, we have 
been greatly assisted by many authorities among whom 
are: — Green, Howell, Thomas, Piersol, Gray, Spalteholz, 
Myers, Barnes, Henouard, Clarke, and those authors who 
have from time to time contributed articles to the current 
embalmers journals. We are deeply indebted to these 
men for the results of their work. 

We have based the treatments given herein on the 
following classification of emblaming fluid as expressed in 
the percentage strength of formaldehyde gas contained 
within the fluid. 

y 2 strength = standard fluid of 5% diluted to 2%% 
% strength = standard fluid of 5% diluted to 3%% 
Normal strength = standard fluid 5 % 

1% strength = standard fluid of 5% raised to 6 1 / 4% 



PREFACE Vll 

As the existence of a calling or profession depends on 
a constant assimilation of newly discovered information 
counterbalanced by the throwing off of that which has 
been found faulty, we commend this book to the embalmer 
and hope that it will meet with all the requirements of 
the higher education, for which we are constantly battling. 

THE AUTHORS. 



TABLE OF CONTENTS 



PART I. 

History, of Embalming. 

CHAPTER I. 

History of Embalming: Page 

Guanch Embalming 3 

Egyptian Embalming 5 

CHAPTER II. 

Embalming from Egyptians down to the Civil War: 

Jews 15 

Parisians 16 

Babylonians 17 

Scythians 17 

Ethiopians 17 

Romans 17 

Greeks 17 

Norsemen 18 

Hindoos 18 

French and Belgians 18 

Britains 18 

Peruvians 19 

Aztecs 19 

North American Indians 19 

Early Christians 20 

Later European Embalming 20 

CHAPTER III. 

Embalming in America after the Civil War: 

Holmes 25 

Billow 26 

Clarke 26 

Renouard 27 

Sullivan 27 

Meyers 27 

Barnes 27 

ix 



X TABLE OF CONTENTS 

PART II. 
Anatomy. 

CHAPTER IV. 

Histology : Page 

Definition 35 

a ceii ;;;;;; ;;;;;; ; 35 

Tissues 37 

Skin 37 

The Nails 40 

The Hair ; 41 

The Fascia 43 

The Lymphatics 44 

Glands 47 

Cartilage 48 

Bones 48 

Teeth 52 

Nerves 53 

Muscles 54 

Tendons 55 

Aponeuroses 55 

Ligaments 55 

Fat 56 

Mucous Membranes 57 

Serous Membranes 57 

Synovial Membranes 57 

Arteries 58 

Veins 60 

Blood 61 

CHAPTER V. 
Osteology : 

Definition 69 

The Skeleton 69 

The Spine 71 

The Skull 72 

The Bones of the Cranium 74 

The Bones of the Face 74 

The Hyoid Bone 75 

The Bones of the Thorax 76 

The Bones of the Upper Extremities 77 

The Bones of the Lower Extremities , 77 

CHAPTER VI. 
Organology : 

The Cavities 79 

The Cerebro-Spinal Cavity 79 



TABLE OF CONTENTS XI 



CHAPTER VII. 



Organology, — Continued : Page 

The Thoracic Cavity 83 

Larynx 84 

The Trachea 85 

The Plteurae 87 

The Lungs 88 

The Mediastinum 91 

The Pericardium (Heart Sac) 92 

The Heart 92 

The Alimentary Canal 96 

The Mouth 97 

The Teeth 97 

The Palate 97 

The Salivary Glands * 98 

The Pharynx 98 

The Esophagus 99 

The Diaphragm 99 



CHAPTER VIII. 

Organology, — Continued : 

The Abdomen 101 

The Stomach 103 

The Small Intestines 106 

Duodenum 107 

Jejunum 107 

Ileum 108 

The Large Intestines 108 

Caecum 109 

The Colon Ill 

The Rectum 112 

Liver 112 

The Gall Bladder 114 

The Pancreas 115 

The Spleen 116 

The Kidneys 116 

The Ureters 117 

The Suprarenal Capsules 117 

The Pelvic Cavity 118 

The Bladder 118 

The Uterus 118 

Prostate, 119 

The Peritoneum 120 



Xll TABLE OF CONTENTS 

CHAPTER IX. 
The Vascular System: Page 

The Vascular System 123 

The Blood Vascular System 123 

The Systemic Circulation .- 125 

The Arterial System 125 

The Capillary Circulation 132 

The Venous System 134 

The Pulmonary Circulation 141 

The Coronary Circulation 142 

The Portal Circulation 144 

The Foetal Circulation 144 

The Collateral Circulation 147 

The Lymphatic Circulation 147 

PART III. 

Embalming. 

CHAPTER X. 

Modes Signs and Tests of Death: 

Modes of Death 156 

Signs of Impending Death 157 

Tests of Actual Death 158 

Later and More Positive Signs 162 

CHAPTER XI. 
Premature Burial: 

Premature Burial 164 

CHAPTER XII. 

Changes in Blood after Death: 

Cooling of the Body 167 

Cadaveric Lividity 168 

Putrefactive Changes 169 

Skin Slip : 175 

Rigor Mortis 177 

Fermentation and the Production of Gas 179 

Spirituous Fermentation 180 

Digestive Fermentation 180 

Metabolic Fermentation 181 

Putrefactive Fermentation 181 

Abdominal Fermentation 182 

Gastric Fermentation 184 

Intestinal Fermentation 185 



TABLE OF CONTENTS Xlll 

CHAPTER XIII. 
Discolorations : Page 

Discolorations 187 

Discolorations Occurring before Death 188 

Yellow Jaundice 188 

Pigmentary Atrophy 189 

Cancerous Spots 190 

Gangrene 191 

Ecchymosis 191 

Wounds . 193 

Fractures 194 

Scars and Tattoo Marks 194 

CHAPTER XIV. 

Discolorations, — Continued : 

Discolorations Occurring after Death 196 

Desiccation 196 

Greenish Tinge of Putrefaction 200 

Chemical Action 202 

Postmortem Discoloration 203 

Postmortem Staining 204 . 

Capillary or Venous Congestion 204 

CHAPTER XV. 

Arterial Embalming: 

Making the First Call 205 

The Position of the Body on the Embalming Board . . 210 

Selection of an Artery 211 

How to Raise an Artery 214 

How to tell an Artery from a Vein or Nerve 215 

How to Cut an Artery for Injection 216 

The Injection of Fluid 218 

Approved Disinfectants 221 

Embalming Fluids 221 

Wrapping a Bodv in Cotton 221 

The Charge of Embalming 222 

CHAPTER XVI. 

The Anatomical and Linear Guides for Special Arteries: 

How to Locate and Inject the Carotid Artery 225 

How to Locate and Inject the Axillary Artery 231 

How to Locate and Inject the Brachial Artery .... 234 

How to Locate and Inject the Radial Artery 237 

How to Locate and Inject the Ulnar Artery 240 

How to Locate and Inject the Femoral Artery 241 



XIV TABLE OF CONTENTS 

CHAPTER XVII. 

Cavity Embalming: Page 

Cavity Embalming 247 

The Cerebral Cavity 247 

Purging 249 

The Thoracic or Chest Cavity 252 

The Abdominal Cavity 254 

The Direct Incision 257 

Embalming of the Subcutaneous Tissue 200 

Plugging Orifices of the Body 262 

Removal of Urine 263 

CHAPTER XVIII. 

The Removal of Blood: 

The Removal of Blood 264 

Right Auricle of Heart. — Direct Method £73 

Right Ventricle of Heart.— Direct Method 274 

Right Auricle of Heart. — Indirect Method '274 

Femoral Vein -' 276 

Axillary Vein 277 

Basilic Vein 278 

Internal Jugular Vein 279 

PART IV. 

Treatment. 

CHAPTER XIX. 

Treatment of Special Diseases: 

Anthrax 285 

Cerebro-Spinal Fever 286 

Erysipelas 287 

Glanders 288 

Hydrophobia 289 

Relapsing Fever 290 

Syphilis 290 

Tetanus 292 

Actinomycosis 293 

Dengue ; 294 

Malarial Fever 295 

Yellow Fever 296 

Diptheria 297 

Tuberculosis 298 

Typhoid Fever 299 

Leprosy 301 

Influenza • • 301 



TABLE OF CONTENTS XV 

Treatment of Special Diseases, — Continued Page 

Cholera 302 

Bubonic Plague 303 

Scarlet Fever 304 

Variola 305 

Measels 306 

Parotitis 307 

Pertussis 308 

Typhus Fever 308 

Varicella 309 

Septicemia 310 

Pyemia 311 

CHAPTER XX. 

Treatment of Special Diseases, — -Continued: 

Diseases of the Respiratory System 312 

Gangrene of the Lung 312 

Pulmonary Hemorrhage 312 

Pulmonary Abscess 314 

Pneumonia , 314 

Hydrothorax 317 

CHAPTER XXL 

Treatment of Special Diseases, — Continued: 

Diseases of the Circulatory System 318 

Pericarditis 318 

Hydropericardium 318 

- . Hemopericardium 319 

Pneumo-Pericardium 319 

Endocarditis 320 

Aortic Incompetency 321 

Aortic Stenosis 321 

Mitral Incompetency 321 

Mitral Stenosis 322 

Tricuspid Incompetency 322 

Tricuspid Stenosis 323 

Pulmonary Incompetency 323 

Pulmonary Stenosis 323 

Cardiac Thrombosis 323 

Hypertrophy of the Heart 324 

Cardiac Dilatation 324 

Cardiac Atrophy 324 

Arterio Sclerosi? ... 325 

i&i Fatty Degeneration of the Arteries 326 

Aneurism 328 



XVi TABLE OF CONTENTS 

CHAPTER XXII. 
Treatment of Special Diseases. — Continued: Page 

Diseases of the Digestive System 329 

Jaundice 329 

Cirrhosis of the Liver m 333 

Carcinoma of the Liver '. 335 

Appendicitis 336 

Peritonitis 336 

Dropsy 337 

Ascites 337 

Anasarca , 339 

CHAPTER XXIII. 
Treatment of Accident Cases: 

Broken Neck 341 

Hanging 341 

Strangulation 341 

Body Severed 342 

The Arm Severed 343 

The Leg Severed 344 

The Head Severed 344 

The Head Crushed ." 345 

The Foot Crushed 345 

The Chest Crushed 346 

Gun-shot in the Abdomen 347 

Burns and Scalds 347 

CHAPTER XXIV. 

Treatment of Posted Cases: 

Cranial Evisceration 351 

Thoracic Autopsy 351 

Abdominal Post 351 

Posted Cases 352 

CHAPTER XXV. 

Treatment of Miscellaneous Cases: 

Alcoholism 354 

Morphinism 356 

Plumbism 356 

Arsenicism 357 

Mercurialism 357 

Heat-Stroke 357 

Obesity 358 

Elephantiasis 359 

Drowned Cases 359 

Floater 359 

Mother and Unborn Child 360 

Senility 361 

Gangrene 362 



LIST OF ILLUSTRATIONS 



Page 

1. View of the skin 36 

2. A cross section of the skin 37 

3. Lymphatics of the head and neck , 45 

4. Lymphatics of the leg 46 

5. Cross section of the bone 50 

6. Section of a nerve fiber 53 

7. View of muscle fibers 54 

8. Section of artery 58 

9. Valves of the veins 60 

10. Cross section through a small artery and vein 60 

11. Human blood 61 

12. The skeleton 69 

13. The spine 71 

14. The skull 73 

15. Brain and spinal cord 80 

16. Front view of the thorax 83 

17. The cartilages of the larynx, the trachea and bronchi 86 

18. The root of the left lung 89 

19. A cross section of the heart showing valves 93 

20. The right auricle and ventricle laid open 94 

21. Passage into trachea and esophagus 98 

22. The regions of the abdomen and their contents 102 

23. The coeliac axis and its branches 104 

24. The caecum and colon laid open to show the ileocaecal 

valve 110 

25. Excretory apparatus of the liver 114 

26. The abdominal aorta and its branches 116 

27. The peritoneum 120 

28. The arch of the aorta and its branches 126 

xvii 



xv111 list of illustrations 

Page 

29. The internal carotid and vertebral arteries 127 

30. The circle of Willis 128 

31. The arteries of the face and scalp 129 

32. The external carotid and its branches 129 

33. The anterior tibial artery 130 

34. The popliteal, posterior tibial, and peroneal arteries . . 130 

35. Capillaries 133 

36. Superficial veins of the head and neck 135 

37. The internal long saphenous vein 136 

38. The superficial veins of the arm 137 

39. Vertical section of the skull, showing the sinuses of 

the duramater 138 

40. The sinuses at the base of the skull 139 

41. The azygos system and the venae cavae with branches 141 

42. The front view of' the heart 143 

43. The back view of the heart 143 

44. Plan of the foetal circulation 145 

45. Collateral anastomosis of veins 147 

46. The arteries of the neck 226 

47. The axillary artery and its branches 232 

48. The brachial artery 235 

49. The radial and ulnar arteries 240 

50. The femoral artery 243 



PART I. 



HISTORY OF EMBALMING 

1 



! . 



Ancient Embalming 



CHAPTER I. 

HISTORY OF EMBALMING. 

Guanch Embalming. — The Guanches with the Egyp- 
tians are the only nation among whom embalming had 
become national, and there exists in the process and 
mode of preservation of both such striking analogy, 
that the study of the Guanch mummies is, probably, the 
surest means of arriving at some positive notions of their 
origin and relationship. The details known of the mode 
of embalming among the Guanches will enlighten and 
complete the descriptions that ancient authors have left 
to us of the Egyptian processes. They were silent on 
desiccation in the act of mummification, but it is to be 
regarded as a simple omission on their part. This 
desiccation was continued during the seventy days 
of preparation, and it constituted the principle part of 
the process adopted. 

The details that I am about to give are extracted 
from the work of M. Bory de Saint Vincent on the 
fortunate Isles. 

"The arts of the Guanches were not numerous, the 
most singular without doubt is that of embalming. The 

3 



4 HISTORY OF EMBALMING 

Guanches preserved the remains of their relations in a 
scrupulous manner and spared no pains to guarantee 
them from corruption. As a moral duty each individual 
prepared for himself the skins of goats, in which his 
remains could be enveloped, and which might serve him 
for sepulture. These skins were often divested of their 
hair, at other times they permitted it to remain, when 
they placed indifferently the hair side within or with- 
out. The processes to which they resorted to make per- 
fect mummies, which they named xaxos, are nearly lost. 

With the Guanches, the embalmers were abject be- 
ings; men and women filled this employment respective- 
ly, for their sexes; they were well paid, but their touch 
was considered contamination ; and all who were occu- 
pied in preparing the xaxos lived retired, solitary, and 
out of sight. 

There were several kinds of embalming, and several 
different employments for those who had charge of it. 
When they had need of the services of the embalmers, 
they carried the body to them to be preserved, and im- 
mediately retired. If the body belonged to persons 
capable of bearing the expenses, they extended it at 
first on a stone table, the operator then made an open- 
ing in the lower part of the belly with a sharpened 
flint, wrought into the form of a knife and called 
tabona; the intestines were withdrawn, which other 
operators afterwards washed and cleaned; they also 
washed the rest of the body, and particularly the deli- 
cate parts, as the eyes, interior of the mouth, the ears, 
and the nails, with fresh water saturated with salt. 



KISTORY OF EMBALMING 5 

They filled the large cavities with aromatic plants; they 
then exposed the body to the hottest sun, or placed it 
in stoves, if the sun was not hot enough. During the 
exposition they frequently endued the body with an oint- 
ment, composed of goats' grease, powder of odoriferous 
plants, pine bark, resin, tar ponce stone, and other ab- 
sorbing material. 

On the fifteenth day the embalming should be com- 
pletely terminated; the mummy should be dry and 
light; the relatives send for it and establish the most 
magnificent obsequies in their power. They sew up the 
body in several folds of skin, which they had prepared 
while living, and they bind it with straps. 

The kings and the grandees were besides placed in 
a case or coffin of a single piece, and hollowed out of 
the trunk of a juniper tree, the wood of which was 
held as incorruptible. 

They then finally carried the xaxos, thus sewed and 
encased, to inaccessible grottoes consecrated to this pur- 
pose. 

Egyptian Embalming. — The Egyptians embalmed their 
dead, and the processes which they employed were suffi- 
ciently perfect to secure them an indefinite preservation. 
This is a fact which the pyramids, the cavern, and all 
the sepultures of Egypt offer us irrefragible proof. But 
what were the causes of the origin of this custom? We 
have in answer only hypothesis and conjecture. In the 
absence of valid documents, each one explains according 
to the bias of his mind, or the nature of his studies, a 
usage, the origin of which is lost in the night of time. 
One of the ancients informs us that the Egyptians took 



6 HISTORY OF EMBALMING 

so much pains for the preservation of the body, believing 
that the soul inhabited it so long as it subsisted. Cassien, 
on the other hand, assures us that they invented this 
method because they were unable to bury their dead 
during the period of inundation. Herodotus, in his 
third book, observes, that embalming had for its object 
the securing of bodies from the voracity of animals ; they 
did not bury them, says he, for fear they would be eaten 
by worms, and they did not burn them, because they 
considered fire like a wild beast that devours everything 
it can seize upon. Filial piety and respect for the dead, 
according to Sicculus, were the sentiments which inspired 
the Egyptians with the idea of embalming the dead bodies. 
De Maillet, in his tenth letter upon Egypt, refers only 
to a religious motive as the origin of embalming: The 
priests and sages of Egypt taught their fellow citizens 
that, after a certain number of ages, which they made 
to amount to thirty or forty thousand years, and at which 
they fixed the epoch of the grand revolution when the 
earth would return to the point at which it commenced 
its existence, their souls would return to the same bodies 
which they formerly inhabited. But in order to arrive, 
after death, to this wished for resurrection, two things 
were absolutely necessary; first that the bodies should 
be absolutely carefully preserved from corruption, in 
order that the souls might re-inhabit them; secondly, 
that the penance submitted to during this long period 
of years, that the numerous sacrifices founded by the 
dead, or those offered to their names by their friends, 
or relation, should expiate the crimes they had committed 
during the time of their first inhabitation on earth. 



HISTORY OF EMBALMING 7 

With these conditions exactly observed, these souls 
separate from their bodies, should be permitted to re- 
enter at the arrival of this grand revolution which they 
anticipated — remember all that had passed during their 
sojourn, and become immortal like themselves. They had 
further the same privilege of communicating this same 
happiness to the animals which they had cherished, pro- 
vided that their bodies inclosed in the same tomb with 
themselves, were equally well preserved. It is in virtue 
of this belief that so many birds, cats, and other animals 
are found embalmed with almost the same care as the 
human bodies with which they have been deposited. 

Such was the idea of perfect happiness which they 
hoped to enjoy in this new life. Surely superstition alone, 
it could scarcely be believed, would induce men to save 
from destruction the mortal spoils of individuals whom 
they had loved whilst living. We much prefer looking 
for the source of this usage in the sentiment which sur- 
vives a cherished object snatched from affection by the 
hand of death. Since death levels all distinctions — re- 
specting neither love nor friendship — since the dearest 
and most sacred ties are relentlessly broken asunder, it 
is the natural attribute of affection, to seek to avoid in 
some degree, a painful separation, by preserving the re- 
mains of those they loved and by whom they were be- 
loved. This according to Saint Vincent. Volney and 
Paraset write as follows as to the probable cause of the 
origin of the custom: In a numerous population, under 
a burning climate, and the soil profoundly drenched dur- 
ing many months of the year, the rapid putrefaction of 
bodies, is a leaven for plague and disease. Stricken by 



8 HISTORY OF EMBALMING 

these numerous pests, Egypt at an early day, struggled 
to obviate them; hence have arisen, on the one hand 
a custom of burying their dead at a distance from their 
habitations; and on the other an art so ingenious and 
simple to prevent putrefaction by embalming. One in- 
dividual may be induced to embalm the bodies of his 
relatives and friends by motives of superstition; another 
from egotism and personal interest; a third from mo- 
tives of salubrity or common interest; another is im- 
pelled to perform the sacred duty of preserving the 
remains of those who were dear to him by an instinctive 
affection. Caylus says that the Egyptians, according to 
appearances owe the idea of their mummies, to the dead 
bodies which they found buried in the burning sands 
which prevail in some parts of Egypt, and which, carried 
away by the winds, bury travelers and preserve their 
bodies, by consuming the fat and flesh without altering 
the skin. 

The mourning, embalming and funerals were con- 
ducted as follows: When a man of consideration dies, 
all the women of his house, cover the head and even the 
face with mud; they leave the deceased in the house, 
girdle the middle of their bodies, bare the bosom, strike 
the breast, and overrun the city, accompanied by their 
relations. On the other side, the men also girdle them- 
selves, and strike their breasts; after this ceremony they 
carry the body to the place where it is to be embalmed. 

Certain men according to the law have charge of the 
embalming, and make a profession of it. When a body 
is brought to them, they show the bearers models of the 
dead in wood. The most renowned represents, they say, 



HISTORY OF EMBALMING 9 

Him whose name I am scrupulous to mention. This* 
model was probably the figure of some divinity. To be 
prepared after this model would cost one talent, (about 
nine hundred dollars of our money). They show a sec- 
ond which is inferior to the first, and which is not so 
costly, twenty mina, (or about three hundred dollars in 
our money). They also show a third of lower price, the 
price of which was considered by Herodotus as a trifle, 
which we would infer to mean from fifty to seventy-five 
dollars of our money. The exhibition of models on the 
part of the embalmers, had reference to the richness of 
the work demanded, and to the expense of the chosen 
form. They demand after which of the three models 
they wish the deceased to be embalmed. After agreeing 
about the price, the relatives retire ; the embalmers work 
alone and proceed as follows, in the most costly em- 
balming. 

They first withdraw the brain through the nostrils, 
in part with a curved iron instrument, and in part by 
means of drugs, which they introduce into the head. 
They now make an incision in the flank with a sharp 
Ethiopian stone. The body is extended upon the earth, 
the scribe traces on the left flank the portion to be cut 
out. He who is charged with making the incision cuts 
with an Ethiopian stone, as much as the law allows; 
which, having done, he runs off with all his might, the 
assistants follow, throwing stones after him, loading him 
with imprecations, as if they wished to put upon him 
this crime. They regard, indeed, with horror, whoever 
does violence to a body of the same nature as their own. 
They withdraw the intestines through this opening, 



10 HISTORY OF EMBALMING 

clean them, and pass them through palm wine, place 
them in a trunk; and among other things they do for 
the deceased, they take this trunk, and calling the sun 
to witness, one of the embalmers on the part of the dead, 
addresses that luminary in the following words, which 
Euphantus has translated: ''Sun and ye too, Gods, who 
have given life to men, receive me, and grant that I may 
live with the eternal Gods: I have persisted all my life 
in the worship of those Gods, whom I hold from my 
fathers, I have ever honoured the Author of my being, 
I have killed no one, I have committed no breach of 
trust, I have done no other evil: if I have been guilty of 
any other fault during life, it has not been on my own 
account, but for these things. ' ' The embalm er in finishing 
these words, shows the trunk containing the intestines, and 
afterwards casts it into the river. As to the rest of the 
body when it is pure they embalm it. 

Afterwards they fill the body with pure bruised myrrh, 
with cannella and other perfumes, excepting incense, it 
is then sown up. When that is done they salt the body 
by covering it with natrum for seventy days. The natrum 
carries off and dries the oily, lymphatic, and greasy 
parts. After the seventy days the body is not permitted 
to remain longer in the salt. The seventy days elapsed, 
they wash the body and entirely envelope it in linen and 
cotton bandages, soaked with gum Arabic. The relatives 
now reclaim the body, they have made a wooden case 
for the human form, in which they enclose the corpse, 
and put it in a chamber destined for this purpose, stand- 
ing erect against the wall. Such is the most magnificent 
method of embalming the dead. 



HISTORY OF EMBALMING H 

Those who wish to avoid the expense, choose this 
other method; they fill syringes with an unctious liquor 
which they obtain from the cedar, with this they inject the 
belly of the corpse without making any incision, and 
without withdrawing the intestines; when this liquor 
has been introduced into the cavity, they cork it; the 
body is then salted for the prescribed time. The last 
day they draw off from the body the injected liquor, it 
has such strength that it dissolves the ventricles and in- 
testines, which come away with the liquid. The natrum 
destroys the flesh, and there remains of the body only 
the skin and the bones. This operation finished, they 
return the body without doing anything further to it. 

The third kind of embalming is only for the poorer 
classes of society, they inject the body with a fluid called 
surmata, they put the body in natrum for seventy days, 
and they afterwards return it to those who brought it. 

As to the ladies of quality, when they are dead, they 
are not immediately sent to the embalmers, any more than 
such as are beautiful or highly distinguished; they are 
reserved for three or four days after death. They take 
this precaution lest the embalmers might pollute the 
bodies confided to their care. 

The relatives now fix the day for the obsequies in 
order that the judges, the relations, and the friends of 
the dead may be present, and they characterize it by say- 
ing that he is going to pass the lake; afterwards the 
judges, to the number of more than forty arriving, place 
themselves in the form of a semicircle beyond the lake. 
A» bateau approaches, carrying those who have charge 
of the ceremony, and in which is a sailor whom the 



12 HISTORY OF EMBALMING 

Egyptians name in their language, Charon. Before 
placing in the bateau the coffin containing the body of 
the deceased, it is lawful for each one present to accuse 
him. If they prove that he has led a sinful life, the 
judges condemn him, and he is excluded from the place 
of his sepulture, if it appear that he has been unjustly 
accused, they punish the accuser with severity. If no 
accuser presents himself or if the one who does so is 
known to be a calumniator, the relatives, putting aside 
the signs of their grief, deliver an eulogism, on the de- 
ceased without mentioning his birth, because they con- 
sider all Egyptians equally noble. They enlarge on the 
manner in which he has been schooled and instructed 
from his childhood; upon his piety, justice, temperance, 
and his other virtues since he attained manhood, and they 
pray the Gods of hell to admit him into the dwelling of 
the pious. The people applauded and glorified the dead 
who were to pass all eternity in the abodes of the happy. 
If any one has a monument destined for his sepulture, 
his body is there deposited; if he has none, they con- 
struct a room in his house, and place the bier upright 
against the most solid part of the wall. They place in 
their houses those to whom sepulture has not been 
awarded, either on account of crimes, of which they are 
accused, or on account of the debts which they may have 
contracted; and it happens sometimes in the end that 
they obtained honorable sepulture, their children or de- 
scendants becoming rich, pay their debts or absolve them. 
The Egyptian embalmers knew how to distinguish 
from the other viscera, the liver, the spleen, and the kid- 
neys, which they did not disturb; they had discovered 



HISTORY OF EMBALMING 13 

the means of withdrawing the brain from the interior 
of the body without destroying the bones of the cranium ; 
they knew the action of alkalies upon animal matter, 
since the time was strictly limited that the body could 
remain in contact with these substances; they were not 
ignorant of the property of balsams, and resins to pro- 
tect the bodies from the larvae of insects and mites; 
they were likewise aware of the necessity of enveloping 
the dried and embalmed bodies, in order to protect them 
from the humidity, which would interfere with their 
preservation. 

The preceding is a description of ancient Egyptian 
embalming as given by Herodotus, and has been the sub- 
ject of numerous commentations, discussions and re- 
searches. It is almost a positive fact that Herodotus has 
omitted desiccation, and that it naturally took place dur- 
ing the time consecrated to preparation. From the mum- 
mies examined it is believed now that the body was first 
salted for seventy days, then dried, and that it was not 
until after this desiccation that the resinous and balsamic 
substances were applied. A simple inspection of the 
mummies is sufficient to confirm this opinion and besides 
what use would have been these resinous matters, with 
which the alkali of the natrum would soon form a soapy 
mass, which the lotions would have carried off, at least 
in great part? It is much more reasonable to suppose 
that these balsamic and resinous substances were not 
applied to the bodies until after they were withdrawn 
from the natrum. 

All the ancients agree, in saying that the Egyptians 



14 HISTORY OF EMBALMING 

made use of the various aromatics to embalm the dead; 
that they employed for the rich myrrh, aloes, canella, and 
cassia lignea; and for the poor, the cedria, bitumen, and 
natrum. The natrum was a mixture of carbonate, sul- 
phate, and muriate of soda. It was a fixed alkali, which 
acted after the manner of quicklime ; despoiling the 
bodies of their lymphatic, and greasy fluids, leaving only 
the fibrous and solid parts. The odoriferous resins and 
bitumen not only preserved from destruction, but also 
kept at a distance the worms and beetles which devour 
dead bodies. 

The embalmers, after having washed the bodies with 
palm wine, and having filled them with odoriferous res- 
ins or bitumen, they place them in stoves, where by means 
of convenient heat these resinous substances united in- 
timately with the bodies, and these arrive in a very little 
time to that state of perfect preservation which we find 
them at the present day. This operation of which no 
historian has spoken, was, without doubt, the principle 
and most important part of their embalming. 






CHAPTER H. 

EMBALMING FROM EGYPTIANS DOWN TO 

CIVIL WAR. 

Here facts are almost entirely wanting and the history 
of the art we are studying, can only be followed in the 
recitals of historians, to control whose veracity we have 
no longer those monuments which Egypt offers us in such 
great numbers. Among the Jews, the Greeks, the Ro- 
mans, and all modern nations, we see the honors of em- 
balming accorded to Kings, Princes and men of distinc- 
tion, but no tomb that has been opened, has rendered a 
single mummy so perfect, as those which we admire among 
the Egyptians. 

Jews. — The Jewish people, who, like others, testified 
their respect for the dead, never admit the care of 
embalming the body as a common usage. Thus Abraham 
purchased the field where Sarah was buried; Joseph had 
the body of his father magnificently embalmed; Moses 
only carried away the bones of Joseph; David praised 
the people of Gilead, for having buried with pomp Saul 
and his sons, etc. In most of these examples, no men- 
tion is made of embalming; nevertheless, the body of 
Jesus Christ was embalmed. It is written that Joseph 
of Arimathea, a secret disciple, and Nicodemus, ministered 
unto him, after the crucifixion, and that 100 lbs. of myrrh 

15 



16 EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 

and aloes were used. In this action the greatest secrecy 
had been observed, for "when the Sabbath was over, very 
early on the first day of the next week, came the faith- 
ful women who had ioved him, with spices and oint- 
ment they had prepared where with to annoint him, not 
knowing that, already, this loving service had been per- 
formed by the hand of pious affection." 

The following is nearly the method used by the Jews : 
Each sex took care of its dead; they first of all, close the 
mouth and eyes of the exposed person, afterward they 
washed the body and then rubbed it with perfumes, 
tied it with bands, and then bandaged it in several cloths 
of very fine linen or woolen ; and finally, they put it into 
the sepulture. It is thought that the myrrh and aloes 
which they employed had very little virtue to resist 
putrefaction, and that the great quantities of aroma- 
tics which they consumed, was rather for pomp, than for 
the long preservation of the subject. They took no pains 
to dry the body ; they did not take away the intestines, 
and in spite of all these odoriferous drugs, decomposi- 
tion must have soon revealed itself as was testified by 
the body of Lazarus when resurrected. 

Persians. — Neither did the Persians possess a very 
great knowledge of preservation. Cyrus, King of Persia, 
said to his children: "when I have ceased to live, place 
my body neither in silver nor in gold, nor in any other 
coffin, but return it immediately to the earth, etc." It 
will be perceived that Cyrus, in forbidding that any 
care should be taken with his body, does not allude to 
embalming, which, of all other means, would have been 



EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 17 

the most efficient in preventing its elements from re- 
turning to the Common Mother. 

Babylonians. — The Babylonians, anointed the bodies 
of their dead with honey, after which, they were im- 
mersed in the same substance. It is highly improbable 
that this process was successful for long time preserva- 
tion, for the preservative power of honey was only equal 
to its ability to keep the air from the body. 

Scythians. — The Scythians coated the bodies of their 
dead with wax. This process could not have been suc- 
cessful excepting to retard decomposition through shut- 
ting off all communication between the body and the 
air. 

Ethiopians. — The Ethiopians coated the bodies of their 
dead with waxy covering called parget. The same com- 
ment given on the Babylonian and Scythian processes 
must also be used here. 

Romans. — The disposition of the dead among the Ro- 
mans embraced the following treatment : the deceased 
was first washed with hot water varied with oil, at in- 
tervals, for seven days ; was dressed and embalmed with 
the performance of a variety of singular ceremonies. 
Cremation was then the means of ultimate disposal of 
the dead, the ashes being gathered and placed in urns 
and then the urns, in turn, were placed in tombs. 

Greeks. — Homer describes cremation, as an honorable 
mode of sepulture practiced in the heroic ages. Later 
from their many conquests, the Greeks acquired the art 
of embalming patterned after the Arabian and Assy- 
rian-Persian methods, of which we have no record. 



18 EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 

Norsemen. — It appears from the sages 'that a form of 
cremation was used by the early Norsemen, who used 
to place the viking in his ship and send him " flaming 
out to sea." Later it became the custom to place him, 
with all his belongings, in his vessel set on an even keel, 
and entomb him beneath a mound of earth. 

Hindoos. — Suttee (from Sati-a virtuous wife), an In- 
dian custom, involving the burning of widows on the 
same funeral pyre as the husband, was the rule until 
1829 A. D. 

French and Belgians. — Paleolithic cave dwellers of 
France and Belgium buried their dead in natural caves 
or crevices, like those in which they lived. Later stone- 
age people throughout Europe buried in chambered bar- 
rows or cairns. Bronze age people buried in unchambered 
barrows or in cemeteries of stone cists set in the ground 
often on a natural eminence, and surrounded by circles 
of standing stones. The cist was formed of a double 
row of stones covered with rude stone slabs. 

Britians. — Neolithic tribes in Britian buried ether in 
caves or in chambered tombs, probably representing the 
huts of the living. Some of these barrows are very 
elaborate and massive ; that of West Kennett is said to 
be 350 feet long. The dead were buried in the British 
tombs as they died, or in a contracted posture, probably 
due to their habit of sleeping in this position, and not 
at full length on a bed. Many cleft skulls are found in 
these tombs, suggesting human sacrifice, which as Caesar 
tells us, was prevalent among the Gauls. The bronze age 
usages were divided between burying and cremation. In 



EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 19 

burying, the contracted posture was followed. In crema- 
tion, the body was placed in a coffin made of the hollow 
trunk of an oak, split in two. In cremation, the ashes 
were collected in a funeral urn, twelve to eighteen inches 
high and were placed in a chamber. Articles of daily 
use were thrown into the fire. 

Peruvians. — The aborigines of the western continent 
were familiar with embalming. Prescott's "Conquest of 
Peru" tells that the royal "Incas" of Peru, were pre- 
served by some process which did not give evidence of an 
external application. These bodies were then secreted 
under mounds of earth and in the interior of the temples. 
Prescott presents highly interesting pictures of these 
embalmed Peruvian monarchs sitting "natural as life," 
in the chairs of the temples of the sun, at Cusco. They 
were clothed as in life, the raven black hair on their 
heads was still unchanged, and their hands were crossed 
upon their bosoms in the grim dignity of death. 

Aztecs. — The Aztecs, who were highly civilized, and 
were one of the most interesting and powerful tribes of 
early America, inhabited Mexico. The Aztecs were con- 
quered by Cortez in 1519. Their history has been traced 
back to the twelfth century. The bodies of their dead, 
especially of those who could claim royal descent, were 
embalmed. It is related in Aztec legends how, after the 
deluge, seven persons came forth from the tomb to which 
their mummified bodies had been committed, and, in re- 
newed existence, repeopled the earth. 

North American Indians. — Even our own North Ameri- 
can Indians knew the art of embalming. Mummies re- 



20 EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 

markably well preserved have been found among the 
Flat Heads, Dakotas and Chinooks ; and the Florida and 
Virginia Indians preserved the bodies of their Kings in 
the same way. The Kentucky caves have given up some 
remarkable specimens of this kind. The bodies of a 
woman and child were, in 1899, found in a cave in the 
Yosemite valley, and which, on account of its size (six 
feet and eight inches), some authorities believe to be a 
relic of the lost tribe of the stone age, possibly antedating 
the Christian era 3,000 years. 

Early Christians. — For a time the early Christians 
embalmed the bodies of their dead, using these forms 
with which they were familiar in Palestine. After a time, 
however, they gave up the practice. It has been said that 
they feared by the continuation of the process to cast 
discredit upon the power of God to call together the 
scattered dust of the body which had returned to its 
native element, and present it, like unto Christ s own 
glorious body, on the morning of the resurrection. No 
word spoken by Jesus, would indicate that he disap- 
proved of methods, with which he as a Jew was familiar, 
to preserve the body from decay. During the first four 
centuries of the Christian era, the catacombs at Rome 
were used for burial. These catacombs consist of sub- 
terranean excavations, long horizontal passages with re- 
cesses on either side, arrayed in tiers for the reception of 
bodies, closed in by slabs bearing inscriptions and em- 
blems of the faith. 

Later European Embalming. — After the previous dis- 
cussion of the care of the dead affecting prehistoric as 



EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 21 

well as the earliest historic usages, we are brought for- 
ward to the seventeenth century. All embalming pro- 
cesses of the earlier days having been forgotten during 
the dark ages. The slow but sure development of the 
medical profession having manifested a dire necessity 
for the preservation of anatomical material, this necessity 
was first met by Dr. Frederick Ruysch, who occupied the 
chair of anatomy at Amsterdam, Holland, during the close 
of the seventeenth and early years of the eighteenth cen- 
tury (1665-1717). 

Dr. Euysch was probably the first to practice a suc- 
cessful system of arterial injection, in order that his 
anatomical specimens might resist the processes of de- 
cay. The reader should understand that embalming as 
a convenient process for preserving human dead bodies 
for funeral purposes had not been thought of at this time, 
and the principal interest in embalming was for its suc- 
cessful preservation of anatomical specimens. The meth- 
od followed by Dr. Ruysch, was first an arterial injection, 
then allowing the diffusion of the fluid for some hours, 
after which, he proceeded to open the body as in making 
a postmortem examination, removing the viscera, clean- 
ing them and replacing them surrounded with a preser- 
vative solution. Dr. Ruysch died, leaving his secrets 
buried with him, and they were lost to science. 

Dr. William Hunter, an eminent Scottish physician, 
anatomist and physiologist of the eighteenth century 
(1718-1783) is given credit by many as being the original 
inventor of the injection system, for he published his 
plan of injection in minute detail, so that science might 



22 EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 

benefit thereby. The artery usually selected by Dr. 
Hunter was the femoral and his solution was composed 
of oil of turpentine five pints; Venice turpentine, one 
pint ; oil of lavender, two fluid ounces ; oil of rosemary, 
two fluid ounces ; and vermillion. This was forced into 
the vessel until it reached over the whole body, giving 
the skin a general reddish appearance. As in Dr. Ruysch's 
method, the body was left untouched for a time, and 
was then opened, the viscera being treated and placed 
back again. After treating the exterior of the body in 
some cases, a coffin was prepared and the body was 
placed on a bed of dry plaster of paris in order that 
desiccation might set in. The body was then left for 
four years and if dryness had not set in by that time, 
was placed upon another bed of plaster of paris. Some 
of Hunter's specimens are to be seen today in the 
museum of the Royal College of Surgeons, London. 

Dr. John Hunter, a younger brother of William, was 
also very active in experimentation along these lines, 
and his work was little less renowned along the same lines. 
The Hunterian method was used for years by English 
anatomists with little if any alteration. 

M. Boudet, attempted to use the Egyptian form of 
procedure in embalming, using as preservative agents 
corrosive sublimate, tan, salt, asphalt, Peruvian bark, 
camphor, cinnamon, and other aromatics. He completely 
enveloped the body in bandages, varnish being coated 
over the body and cavities and outer bandages. 

M. Franchini, injected the common carotid artery 
with a solution made up of eight decigrams of arsenious 



EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 23 

acid, combined with a small quantity of cinnabar, dis- 
solved in nine kilograms of spirits of wine. By this meth- 
od bodies could be kept odorless and natural in color for 
sixty days, after which desiccation set in. 

Jean Nicholas Gannal, and his son Dr. Gannal of Paris, 
injected chloride of alumina with success, J. N. Gannal, 
had previously, a formula containing arsenic, which the 
French Government compelled him to discontinue by 
prohibiting the sale of the arsenic. In addition to the 
above treatment the body was placed in a lead coffin and 
four or five litres of various essences were poured over 
the body and the casket was soldered. In this way pre- 
servation was said to be indefinite. 

M. Sucquet, injected a solution of chloride of zinc 
arterially, and in one body' which was taken up after 
being buried 14 months achieved remarkable success, the 
incident being the result of a contest between M. Gannal, 
M. Dupre, and M. Sucquet. This led to the use of the zinc 
salts in fluid, not only in Europe but in this country 
as well. 

M. Falcony, desiccated the body in a mixture which 
Avas composed of saw dust and powdered zinc sulphate. 
Bodies so preserved remained flexible for about forty 
days, after which they dried up, although still retaining 
their natural color. 

Franciolli, used arsenic acid, four ounces; carbonate 
of potash two ounces ; powdered alum, eight ounces. lie 
completely eviscerated the body and then injected it in 
all directions, afterwards replacing the organs and sur- 
rounding them with liquid preparation composed of corn 



24 EMBALMING FROM EGYPTIANS DOWN TO CIVIL WAR 

starch, water, alcohol, and corrosive sublimate, which 
after hardening, would prevent the sinking of the parts. 
Many processes are noted in the various histories of 
the art, all using the arterial injection, which by this 
time had become universally accepted as the only true 
way of reaching the body tissues completely. The reader 
has noted absolutely nothing as to embalming being the 
most convenient process for funeral purposes. This is 
left to the following matter which begins with the em- 
balming done by Dr. Thomas Holmes during .the civil 
war (1861-1865 A. D.) 



CHAPTER III. 

EMBALMING IN AMERICA AFTER THE 
CIVIL WAR. 

Dr. Holmes was authorized by the U. S. Government 
to prepare the bodies of slain troops, so that they could 
be transported to their former homes. The practice of 
embalming for funeral purposes received its greatest 
impulse during the regime of Dr. Holmes, and it opened 
up an era of unprecedented discovery and success in pre- 
serving the dead body. 

After Holmes, the man who cared for the dead began 
to feel that his was a professional work worthy of the 
name. The average undertaker, at the time just after 
the civil war, was a cabinet maker, whose chief function 
was to make the coffin or casket for the body, take the 
casket to the house and place the body in it. Then the 
larger undertakers in the larger cities found that they 
were compelled to preserve some of the bodies in some 
way so that distant relatives could reach the scene be- 
fore the funeral. This probably was the result of better- 
ments in transportation facilities which led people to 
travel more. Along with this, travelers frequently died 
away from home and had to be shipped. The baggage 
men rightfully objected to remaining in the same en- 
closed space with an unembalmed body and, altogether, 

25 



26 EMBALMING IN AMERICA AFTER THE CIVIL WAR 

a condition arose in which it was necessary to have some 
way to preserve the body. 

As evolution is always a slow process, we cannot as 
we would like to do, chronicle the introduction of chemical 
embalming at this time, for refrigeration was the first 
thing thought of. The ice box, was the means by which 
bodies were kept for several days ; the body being cov- 
ered and left that way until a few hours before the 
funeral. This became so unsatisfactory specially when the 
sensibilities of the undertaker became sharpened, that 
they immediately looked about for a more convenient 
way to handle the situation. Spurred on by this demand, 
several concerns came into the market with preservative 
solutions with an arsenical base, and which were used 
principally for external application and cavity injection. 
All kinds of instruments were used with which to in- 
troduce the fluid into the body cavities until Captain 
George Billow, of Akron, Ohio, a civil war veteran, and 
at present a member of the Ohio State Board of Em- 
balming examiners, contrived the pen point trocar, which 
is still in use among the profession. 

With the introduction of the trocar, and the campaigns 
of the fluid manufacturers, trade periodicals and travel- 
ing men, cavity embalming became the means of preser- 
vation, until its limitations were learned. 

Joseph Henry Clarke, who first traveled for fluid 
houses, and who was interested in the anatomy of the 
human body, since his connection with the U. S. hospital 
service in the Civil war, determined to introduce the 
arteral injection as the means of placing the fluid through 






EMBALMING IN AMERICA AFTER THE CIVIL WAR 27 

the body. In collaboration with Dr. C. M. Lukens, the 
occupant of the chair of Anatomy at the Pulte Medical 
College of Cincinnati, Prof. J. H. Clarke opened a school 
of embalming naming it the Cincinnati School of Em- 
balming. This took place during the year 1882. Prof. 
Auguste Renouard of Denver, Colorado, came into the 
field about the same time. Thus we have the beginning 
of the greatest revolution of all times in the care of the 
dead human bodies. 

After Prof. Clarke and Prof. Renouard, came Prof. 
Frank Sullivan, and from time to time the list was 
augmented by the addition of others, a few of whom 
being Dr. Eliab Meyers, of Springfield, Ohio, Dr. Carl L. 
Barnes of Chicago, etc. With the efforts of all these men, 
the undertakers were led to use the arteries more and 
more until now, at the present time, this form of embalm- 
ing is used exclusively through the United States, and 
Canada ; European countries not having, as yet progressed 
as rapidly in that direction. The additions to the work 
from the time just previous to the start given to it by 
Prof. Clarke, number all the methods which we use to- 
day, including, the injection of any large artery in the 
body ; the drainage of blood to further the obtaining of a 
complete circulation ; the various processes by which 
discolorations are prevented and cured; the various pro- 
cesses by which bodies are disinfected; the various pro- 
cesses by which features are restored and many other of 
the vital operations of the present time. The undertaker 
having progressed from the cabinet maker, to a man of 
professional bearing having a good knowledge of all 



28 EMBALMING IN AMERICA AFTER THE CIVIL WAR 

things pertaining to the dead human body, is now a 
man in whom the greatest reliance may be placed. Where 
previously, he was uneducated and uncultivated in mat- 
ters pertaining to the body, he is now an authority to 
a great extent. 

As a part of this historical contribution, we can- 
not overlook the very great advance made in the nature 
and composition of the preservative solutions used today. 
When formaldehyde was introduced, the high cost of 
it prevented its immediate use ; but, later on, improved 
methods of manufacture brought the cost down to such 
a point where it became an essential ingredient in the 
fluids. Later when, on medico-legal grounds, arsenic 
was prohibited in the fluid (this action paralleling the 
action taken by France in the case of J. N. and Dr. 
Gannal), formaldehyde was depended upon for the max- 
imum preservative action. Thus it still remains the base 
of most of the modern fluids. Several compounders have 
discontinued its use, preferring phenol, creosote, etc., but 
these chemicals have not as yet, made much progress 
against the formaldehyde. 

In the early days, when the fluids were likely to be 
inadequate to care for certain conditions, the question 
as to which fluid is to be used was the principal care of 
the embalmer. Today, when the standard fluids are of the 
highest possible efficiency, it is a question of knowledge 
and technic on the part of the embalmer; it being a 
recognized fact that there is only about 1 chance in 1,000 
for a standard fluid to contain inferior elements. In this 
way we may state that the burden of obtaining success 



EMBALMING IN AMERICA AFTER THE CIVIL, WAR 29 

has been shifted from the fluid, to the man using it; and 
it is then unnecessary to state that the best preparation 
along the line of education for the embalmer is advised, 
so that by his knowledge, he may do what he is expected 
to do by the people whom he is serving. 



PART II. 



ANATOMY 

31 



Anatomy 



The word anatomy is derived from two Greek words, 
meaning, to cut apart, which literally means dissection. 

Anatomy is used to indicate the study of the physical 
structure of organized bodies. 

Anatomy is the science of organization or the science 
of organic structure. 

Human anatomy is divided into two great divisions, 
known as (a) general or descriptive anatomy and (b) 
surgical or regional anatomy. 

Descriptive anatomy deals with the separate parts 
of the human body. 

Histology is that part of descriptive anatomy where 
the separate parts of the human body are studied by 
means of the microscope. 

Osteology is that part of descriptive anatomy de- 
scribing the number, form, structure and uses of bone. 

Myology is that part of descriptive anatomy which 
treats of muscles. 

Neurology is that part of descriptive anatomy which 
treats of nerves. 

Syndesmology is that part of descriptive anatomy 
which treats of ligaments. 33 



34 ANATOMY 

Angiology is that part of descriptive anatomy which 
treats of the blood-vessels and lymphatics. 

Surgical or regional anatomy describes the relation 
which certain parts, — muscles, nerves, arteries, etc., — 
bear to each other. 



CHAPTER IV. 

HISTOLOGY. 

Definition. — Histology is that part of descriptive ana- 
tomy which treats of the intimate structure of the tissues 
as seen under the microscope. 

Histology as taught in most professional schools con- 
stitutes a one year's course, but for the embalmer this 
is not entirely necessary and with the short term of school- 
ing now existing it is quite impossible, but certain of 
the fundamental principles of histology are important. 
For this reason a few of the more important tissues have 
been discussed, not, however, in great detail, but only 
superficially, merely to have the embalmer acquainted 
with them. 

A Cell. — A cell is defined as a nucleated mass of pro- 
toplasm endowed with the attributes of life. 

Protoplasm is the name applied to the semi-fluid, 
granular substance contained within the cell. 

The simplest forms of animal life are organisms con- 
sisting of only one cell which are called protozoa. 

Cells having similar shape and similar functions are 
grouped to form tissues. 

Tissues are grouped together to form organs. 35 



36 



HISTOLOGY 



Every cell consists of a cell body and a nucleus. The 




Fig. 1 — A, A vertical section of the cuticle; B, the lateral view of the 

cells; C, the flat side of scales like (d) magnified 

250 diameters. 



cell body consists of a substance known as protoplasm. 
The nucleus is the essential part of a typical cell and 
is the controlling center of its activity. 

Cells divide or reproduce themselves by means of 
direct or indirect division. In direct division the nucleus 
and the cell wall simply divide into two equal divisions 
and results in the formation of two new cells. In in- 
direct division the process is much more complicated, 
and several stages must be passed through before there 
is a complete division. 

The process of fertilization consists in the conjugation 
of two sexual cells. The male sexual cell is called the 
spermatazoon, and the female sexual cell is called the 
ovum. 

The nucleus of the ovum in its earlier development 
stages is known as the germinal vessicle. 

In the living organism many cells are destroyed during 
the various physiologic processes and are replaced by new 



HISTOLOGY 



37 



ones. When a cell dies, changes take place in the nu- 
cleus which result in its gradual disappearance. This 
process is known as chromatolysis. 

Tissues. — A tissue is an aggregate of cells all having 
a common function. 

Those important tissues with which the embalmer 
should be more or less acquainted are the following : 

Skin, nails, hair, superficial fascia, deep fascia, lym- 
phatics, glands, cartilage, bone, teeth, nerves, muscles, 
tendons, aponeuroses, ligaments, fat, mucous membranes, 
serous membranes, synovial membranes, arteries, veins 
and blood. 

The Skin. — The skin or integument (intego, to cover) 
is the outside covering of the human body. It is the 

first tissue that is cut when 
operating upon the body. 

The skin is the seat of the 
organs of touch. The multi- 
tudes of sensory nerve endings 
convey the sensations of tem- 
perature, pressure and pain to 
the brain, thus informing the 
brain at all times, to keep the 
body from harm, and in a 
strong and healthful condition. 
The skin is also the regulator 
of the body temperature, for 
connected with the skin are* 
sweat glands, and sebaceous 

Fig. 2-A cross section of S lands > each having important 
the skin. (Gray; excretory functions. 




38 HISTOLOGY 

The skin is also a protective coat, very elastic, and 
varies greatly in thickness. It is thinnest in the eye- 
lids and thickest over the back of the neck, back of the 
shoulders, palms of the hands and the soles of the feet. 

The color of the skin depends upon two things, first, 
on the pigment, which is found, one of the discriminating 
points between the races, named by the color of the skin 
as white, black, yellow, etc. ; second, the color depends 
upon the amount of blood in circulation, the deepest hue 
being in the parts exposed to the air, light and the varied 
temperatures. Besides these the color of the skin varies 
with age, pinkest in the infant and becoming yellow with 
old age. It varies with exposure and with climate, the 
people living in the north having a much different com- 
plexion than those living in the south under the tropical 
sun. The color of the skin also varies with certain dis- 
eases, being extremely pale in anaemia, brown in Addi- 
son's disease, and yellow in jaundice. 

The skin can be said to be moveable, although in 
places it is attached firmly to the underlying structures, 
especially on the scalp, the soles of the feet, and the palms 
of the hands. 

Upon close examination the skin discloses a multitude 
of openings, creases, furrows, depressions, folds and 
hairs. 

A dimple is a permanent pit or depression due to the 
adhesion of the surface to parts beneath. 

Structure. — The skin consists of two intimately con- 
nected structures, the one is the true skin, corium, or 
dermis and is the deepest layer of the skin ; and the other 



HISTOLOGY 39 

is the false skin, cuticle, or epidermis, and is the outer- 
most layer of the skin. 

The true skin, is composed mostly of connective tis- 
sues and elastic fibers. It is the real seat of the sense 
of touch, for it is here that the sensory nerves have their 
termination. In this layer we also have the termination 
of the minute capillaries of the skin. 

The false skin, contains no blood vessels or nerves, 
and being without these it is practically dead tissue, and 
to illustrate this fact one can take a needle and run it 
through this outside layer without the least pain or the 
drawing of blood. 

The false skin is the part which slips off in case of 
skin slip. In as much as the minute capillaries end at 
the termination of the true skin, when putrefaction and 
fermentation begin there is an oozing of water from the 
capillaries and the surrounding tissues, between the two 
layers of skin, causing a blister to form, and known as 
skin slip. 

At the lowest part of the false skin is a layer of 
germinal cells, from which all the other cells are derived, 
and becoming more flattened and horny as they are push- 
ed farther away from the blood supply; and also a layer 
of pigment cells, which give the discriminating color to 
the skin. 

In the skin are seen numerous sebaceous and sweat 
glands. 

The sweat glands are the organs by which a large 
portion of the aqueous and gaseous materials are excreted 



40 



HISTOLOGY 



by the skin. Sweat glands are found in almost evary 
portion of the skin, and are situated in small pits below 
the surface of the skin, surrounded by a quantity of 
adipose tissue or fat. They are small, round, reddish 
bodies, consisting of a single tubule, convoluted in form, 
which extends up through the skin and opens on the sur- 
face. The size of these glands, of course, vary, being 
especially large in those regions where the flow of per- 
spiration is copious as in the axilla. 

The sebaceous glands are small, sacculated, glandular 
organs, lodged in the substance of the skin. They are 
found in most parts of the skin and are usually con- 
nected with the hair follicles. Each gland consists of a 
single duct, more or less capacious, which terminates 
in a cluster of small secreting pouches or saccules. These 
glands secrete an oily fluid, which keeps the skin soft 
and also oils the shaft of the hair. 

The Nails. — The nails are a peculiar modification of 
the epidermis and have the same cellular structure as that • 
of the epidermis. The nails are found on the dorsal sur- 
face of the fingers and toes and act as a protection, and 
enable one to pick up small objects, or to grasp more 
firmly any object. Were it not for the nails it would 
be impossible for one to pick up a needle from off the 
floor. 

Each nail is convex on its outer surface, and its chief 
mass which is called the body lies upon the nail bed, or 
true skin; the free end projects out over the surface of 
the finger, and is that part which is not attached below, 
and since it is the continuation of the epidermis, it like- 



HISTOLOGY 41 

wise will have no nerve or blood supply and therefore 
can be trimmed without pain to the individual. 

The root is implanted in a groove in the skin and 
is composed of cells which have not become horny. The 
root is white in color and is the little half moon which 
you can see next to the skin. 

The matrix is that part of the true skin beneath the 
body and the root of the nail, and is so called, because, 
it is that part from which the nail is produced and so 
long as the matrix at the root of the nail is uninjured, 
the nail will be reproduced after an accident. 

After death the nail turns black, due to the infiltra- 
tion of blood into the matrix. 

Treatment by the Embalmer. — The blackened condi- 
tion of the nail due to the infiltration of blood into the 
matrix can in many cases be overcome by carefully rub- 
bing the nail at the time the body is being injected. After 
the discoloration is removed the fingers should be kept 
elevated so that the blood will not settle there again. 

The Hair. — The hair, like the nails, is a peculiar modi- 
fication of the epidermis and consists of practically the 
same cellular structure as the epidermis. Hair is found 
on nearly every part of the body excepting the palms 
of the hands and the soles of the feet, the borders of 
the lips, etc. It varies much in length, thickness and in 
the different races of mankind. In the eyelids it is short, 
on the scalp it is of considerable length. In other parts 
as the eye-lashes, the hair of the pubis region, the whis- 
kers and beard the thickness is remarkable. 

A hair consists of the root and the shaft. The root 



42 HISTOLOGY 

of the hair or that part implanted in the skin presents 
at its extremity a bulbous enlargement, called the hair 
bulb. Into this bulb we find the small arterial capillary 
circulating and at its termination the beginning of the 
venous capillary. In this way the hair is nourished in 
life. We also find a small nerve going to the hair bulb. 
The shaft is the remaining part or that part coming out 
from the skin. 

The hair grows from its roots and as it grows it 
pushes itself out from the skin and owes its growth to the 
small capillary circulation, carrying pure arterial blood to 
each and every hair, and for this reason you can under- 
stand for yourself the erroneous idea of what is termed 
the "post-mortem growth of hair." Only a few weeks 
ago one of the students declared that he had actually seen 
a subject shaved and the body at the time of the funeral 
was placed in a vault to await the arrival of a close rela- 
tive who had to come from Europe. 

Three weeks later the student, together with the un- 
dertaker and relatives, went to the vault to view the re- 
mains. The body was in a perfect state of preservation, 
only for a large growth of beard as the student supposed. 
This student had observed rightly, but he did not go 
far enough. He did not think of how the hair actually 
got its nourishment. The hair owes its life to the circu- 
lation of the blood, just as much as the heart or any 
other organ does, and will die and cease to grow just 
as soon as the body dies and the circulation is cut off. 
What this student saw was only an apparent growth, for 
after the body dies the tissues begin to shrink, squeezing 



HISTOLOGY 43 

the blood and fluid substances out of them, thus giving 
the hair cylinder a more projected appearance. 

The student was very much surprised at his mistake, 
but after the explanation he saw that the hair owed its 
life to the circulation and that when this circulation was 
cut off, the hair must cease to grow. 

The chief function of hair is that of protection from 
heat or cold and to help shield the brain from the effect 
of a blow upon the head. 

The hair, next to the teeth and bones, is the least de- 
structible part of the body. 

The Fascia. — The fascia (fascia, a bandage) is are- 
olar or aponeurotic tissue of variable thickness and 
strength found in all regions of the body and invests or 
surrounds the softer and more delicate organs. From 
its situation in the body the fascia is divided into two 
groups, superficial and deep. 

Superficial fascia is found immediately beneath the 
skin over almost the entire surface of the body. It con- 
nects the skin with the deep fascia and consists of areo- 
lar tissue. 

The superficial fascia varies in thickness in different 
parts of the body and some places, especially in the groin 
is capable of being subdivided into several different 
layers. The first layer of the superficial fascia, which 
is just beneath the skin, usually contains a great amount 
of fat or adipose tissue. This, in most text books, has 
been termed the subcutaneous tissue. The second layer 
is comparatively devoid of adipose or fatty tissue and 
in this we find the trunks of the subcutaneous vessels and 



44 • HISTOLOGY 

nerves, as for example, the radial and ulnar veins in the 
arms and the saphenous vein in the leg. 

The superficial fascia facilitates the movement of the 
skin, serves as a soft medium for the passage of the ves- 
sels and nerves to the skin and retains the warmth of 
the body, since the fat contained in its meshes is a bad 
conductor of heat. 

Deep fascia or aponeurotic fascia is a dense inelastic, 
unyielding fibrous membrane, forming a sh°ath for the 
muscles and affording them broad surfaces for attach- 
ment. On removal of the superficial fascia, the deep 
fascia is usually exposed and can be seen as a dense, 
tough membrane, which not only binds down the muscles 
to each region, but gives to each a separate sheath as 
well as to the blood vessels and nerves. 

Thus, on going down into the arm between the biceps 
and triceps muscles to raise the brachial artery, you 
would first cut through the skin, then the subcutaneous 
tissue, the superficial fascia and then you would come 
to a membrane investing the artery, vein and nerve. 
This membrane is the part of the deep fascia which 
covers the vessels, making a distinct sheath for them and 
you must go through this sheath before you can hope 
to raise the artery. 

The Lymphatics. — The lymphatics occur in all parts 
of the body, and in many respects resemble the veins, 
one of the most striking similarities being that the lym- 
phatics contain valves just the same as the venous system. 
The lymphatic capillaries are arranged in the form of 
a net work and resemble closely in structure the blood 



HISTOLOGY 



45 



capillaries. These capillaries then unite to form the 
lymph vessels and these then convey the lymph to the 
subclavian veins. The lymph is a colorless fluid and 




Fig. 3 — Lymphatics of the head and neck. 
B, the thoracic duct. 

contains numerous blood corpuscles known as lympho- 
cytes. But in those lymphatic vessels, which have their 
origin in the walls of the small intestines, the lymph, 
especially during digestion, contains a great amount of 
fat, so that it has a milky appearance, and for this reason 
the lymphatics 'of this region, have been termed lacteals. 
There are two main lymphatic trunks, the one on the left 
side is called the thoracic duct. This duct extends from 
the lower border of the second lumbar vertebraj through 
the entire length of the thorax, and opens into the left 



46 



HISTOLOGY 



subclavian vein, close to the point where it is joined to 
the left internal jugular. It receives the lymph from the 

lower limbs, the pelvic walls and 
viscera, the abdominal walls and 
viscera; the lower part of the 
right half and the whole of the 
left half of the thoracic viscera, 
the left side of the neck and head 
and the left arm. 

The other duct is called the 
right lymphatic duct and receives 
lymph from the upper part of 
the right side of the thoracic wall, 
part of the right side of the dia- 
phragm and the right lobe of the 
liver, the whole of the right arm 
and neck and right side of the 
head. This trunk is very short 
and empties its supply of lymph 
into the right subclavian vein. 

Receptaculum chyli is the ex- 
panded portion of the thoracic 
duct just at its beginning. Its 
function is to receive the lacteals 
which come from the villi of the 
intestines. 

Lymph glands are the enlarge- 
ments of the lymph vessels. They 
Fig. 4-Lymphatics of occur frequently in the lymphatic 
the leg. system, being most numerous in 




HISTOLOGY 47 

the axillary space, the cervical region (in the neck) 
and in Scarpa's triangle. 

The lymphatic system aids greatly in warding off such 
diseases as blood poisoning, anthrax, etc. 

The lacteals are the lymphatics which carry the 
chyme from the villi of the intestines and deposit it in 
the receptaculum chyli. 

Glands. — The glands of the human body are divided 
into three classes called tubular, aveolar and tubulo- 
alveolar glands. 

Tubular Glands. — In these, the secreting portion con- 
sists of a long or short tubule, which may be relatively 
straight or variously twisted, one end of which ends 
blindly, while the other end opens on the free surface 
or into a duct. 

Tubular glands may be simple, or having only a single 
tubule ; they may be simple branched, having more than 
one tubule ; or they may be compound branched, thus 
resembling the branching of a tree. 

Some tubular glands would be the liver, kidneys, 
testes, lachrymal glands, serous glands of the mucous 
membranes, fundus glands of the stomach, uterine glands, 
the majority of the pyloric glands and the majority of 
the sweat glands. 

Alveolar Glands. — In these, the secreting compart- 
ments have the form of variously shaped vesicles or sac- 
cules, known as alveoli which open on the free surface 
or into a duct. 

Alveolar glands may be either simple, simple branched, 
or compound branched. 



48 HISTOLOGY 

Some alveolar glands would be the sebaceous glands, 
pancreas, mammary gland, ovary and thyroid. 

Tubulo-alveolar Glands. — In these, there is a combina- 
tion of the tubular and the alveolar type. They may 
also be simple, simple branched or compound branched. 

Some of this type would be certain of the pyloric 
glands, certain of the sweat glands, some mucous glands, 
the prostate and the lungs. 

The most important glands will be discussed under 
the tissue or the organ in which they are situated. 

Cartilage. — Cartilage is a transition stage between 
connective tissue and bone ; when it is boiled it yields 
condrin. It is found in various parts of the body, in 
the adults being found chiefly in the joints, in the sides 
of the thorax, and in various tubes which are not kept 
permanently open, such as the air passages, nostrils, ears, 
etc. In the foetus, the greater part of the framework is 
cartilaginous and as the foetus matures this cartilage 
is finally replaced by bone. Cartilage is divided into 
hyaline cartilage, elastic cartilage, and fibro cartilage. 

Hyaline cartilage is found in the nose, larynx, tra- 
chea, and bronchi. 

Elastic cartilage is found in the epiglottis and the 
cartilages of the larynx. 

Fibro cartilage is found at the point of insertion 
of the ligaments, into the body of the bone, such as the 
cartilage which helps to hold the femur or long bone 
of the thigh into the hip. 

Bones. — Bone results from the calcification of cartil- 
age or fibrous tissue. It is a highly specialized form of 



HISTOLOGY 49 

connective tissue. There are two varieties of bone; 
dense or compact bone and cancellous, loose, or spongy 
bone. Compact bone is dense, like ivory, and is always 
found on the exterior of bones. 

Cancellous bone is found in the interior of bones, and 
has a lattice-work appearance. 

Bone consists of one-third animal or organic matter 
and two-thirds earthy or inorganic matter. These pro- 
portions, however, vary with age. In youth it is nearly 
half and half, while in the adult the earthy is greatly 
in excess. It also varies with disease. With some de- 
fect of nutrition, the bone is deprived of its normal pro- 
portion of earthy matter, while the animal matter is of 
unhealthy quality, and we have as a result, a disease 
called rickets, so common in the children of the poor. 
The earthy or inorganic matter consists of phosphate, 
carbonate, fluoride of calcium, sodium chloride, and 
phosphate of magnesium. The animal matter consists of 
fat collagen, which when boiled with water is resolved 
into gelatin. 

To illustrate the two substances, take a bone and place 
it in dilute hydrochloric acid. The acid will eat out all 
the mineral matter and we have left only the animal 
matter. After this operation one can take the bone and 
can bend it into any position whatever, which experiment 
shows that the animal matter gives elasticity to the bone. 

The second experiment would be to put the bone on 
a bed of hot coals and burn it. Only the animal matter 
will burn and we will have the mineral matter remaining. 



50 



HISTOLOGY 




After this operation one will find that the bone is very 
brittle and will easily break, which experiment shows 
that the mineral matter gives stability and support to 
the bone. 

If a cross section is made of any 
long bone, such as the humerus, 
and this section placed under the 
low power of the microscope, the 
Haversian canal system can be 
discerned. The Haversian canal 
system consists of the numerous 
small openings or canals through 
which the blood vessels ramify in 
distributing the nourishment to 
the bone. Around each individual 
canal are seen smaller spaces ar- 
ranged in a circle. These are known 
as the lacunae (small lakes). Going from the lacunae 
are smaller canals which take on the name canalicular 
and joining all the lacunae together, making the appear- 
ance of concentric circles, we have the lamellae. The 
outside covering of the bone is called the periosteum and 
the inside covering is called the endosteum. Most of 
the long bones and many of the smaller bones are sup- 
plied by a nutrient artery, which enters the bone near 
its center, enters the bone marrow, and divides into 
two branches, one going up and the other down in the 
marrow. The blood is then distributed through the Hav- 
ersian canal system. Veins emerge from the long bones 
in three places: 1. One or two large veins accompany 



Fig. 5 — Cross section of 
bone. (Sharpey) 



HISTOLOGY 51 

the nutrient artery. 2. Numerous veins emerge from 
the articular extremities. 3. Many small veins arise 
in and emerge from the compact substance. 

Bones are divided, according to shape, into four 
classes: long, short, flat and irregular. 

Long Bones. — These bones are usually used as a sys- 
tem of levers to confer the power of locomotion. A long 
bone consists of a shaft and two extremities. The shaft 
is a hollow cylinder within which is the medullary canal. 
The extremities are somewhat expanded for the purpose 
of articulation, and to afford a broad surface for the 
attachment of muscles. The long bones are as a rule 
curved in two directions to give greater strength to the 
bone. Some examples of this class of bone are the 
clavicle, radius, ulna, humerus, femur, tibia, fibula, meta- 
carpal, metatarsal, and the phalanges. 

Short Bones. — These bones are placed in that part 
of the skeleton where there is need for strength and com- 
pactness, and where the motion of the part is slight and 
limited. Some examples of this class of bone are the 
bones of the carpus and tarsus (in the hand and the 
foot). 

Flat Bones. — Flat bones are found where the prin- 
ciple requirement is either extensive protection, or the 
need of a broad surface for the attachment of muscles. 
Some of the bones of this class are the occipital, parietal, 
frontal, nasal, lachrymal, vomer, scapula, sternum, and 
the ribs. 

Irregular Bones. — These bones are such as from their 
peculiar shape and form can not be grouped under any 



52 HISTOLOGY 

of the preceding heads. Some of the bones of this class 
are the vertebrae, sacrum, coccyx, temporal, sphenoid, 
ethmoid, etc. 

If the surface of a bone is examined, certain articular 
and non-articular eminences and depressions will be seen. 

Articular Eminences. — Examples of this class are 
found in the heads of the humerus and the femur. 

Articular Depressions. — Examples of this class are 
found in the glenoid cavity # of the scapula and the 
acetabulum. 

Non-articular Eminences. — These are designated ac- 
cording to their form. 

A tuberosity is a broad, rough, and uneven elevation. 

A tubercle is a small, rough prominence. 

A spine is a sharp, slender, pointed eminence. 

A ridge, line, or crest is a narrow, rough elevation, 
running some way along the surface. 

Non-articular Depressions. — These are of variable 
form, and .are described as notches, sulci, fossae, grooves, 
furrows, fissures, etc. These non-articular eminences and 
depressions may serve to increase the extent of surface 
for the attachment of ligaments and muscles or may 
receive blood vessels, nerves, tendons, ligaments, or por- 
tions of organs. 

Canals or foramina are channels or openings in bone 
through which pass the nerves and blood vessels. 

Teeth. — In the human body we find two sets of teeth. 
One appearing in childhood, and are known as milk teeth, 
twenty in number, the permanent teeth replacing these 
about the sixth year. 



HISTOLOGY 53 

There are thirty-two permanent teeth, divided into 
four incisors, two canines, four bicuspids and six molars. 

Teeth are made up of three different substances, which 
are known as enamel, dentine and cement. 

The enamel is a very hard substance, the hardest in 
the body, and may be compared to quartz. The enamel 
covers the entire tooth down as far as the gums. 

The cement is a continuation of the enamel below the 
gums, and is closely adherent to the dentine. The ce- 
ment consists of bone tissue, but the lamellae as a rule 
do not contain Haversian canals. 

The dentine is, next to the enamel, the hardest tissue 
of the tooth, and composes the main body of the tooth. 
The pulp cavity is found within the center of the tooth, 
with the opening toward the jaw bone. The tooth is 
nourished by a nutrient artery and vein and nerve which 
pass into the pulp of the tooth. 

Nerves. — Nerves are divided into two general classes, 
called medullary and non-medullary nerves. The non- 
medullated type arise mostly from the sympathetic sys- 
tem, while the medullated type arise from the brain and 

cord. As a rule, the nerves of 
the body follow the course of 
the arteries, and are generally 
Fig. 6-Sectionofa nerve fibre, found in the same sheath with 
(Klein and Noble Smith) the artery and vein 

They are easily distinguished from the arteries and 
veins by touch and by their color, being very inelastic 
and fibrous, hard to the touch, and unlike the artery 
or vein, since they have no central opening. 



54 



HISTOLOGY 



Muscles. — Myology is that branch of anatomy which 
treats of the muscles. The muscles are formed of bun- 
dles of reddish fibres, endowed with the property of con- 
tractility. In the body we find two kinds of muscular 
tissue, called voluntary and involuntary muscle. The 
voluntary type is characterized by the 
striped appearance which it displays when 
seen under the microscope, and for this 
reason it is called striped or striated 
muscle. It is so named "voluntary" be- 
cause it is capable of being put into ac- 
tion and controlled by the will. The in- 
voluntary muscles do not present any 
striped appearance, and consequently are 
called unstriped or non-striated, and are 
not under the control of the will. An 
example of voluntary muscle would be 
any muscle of the bony framework as 
for example, the biceps or triceps. 
An example of involuntary muscle would be those of 
the intestines and stomach, the muscles of the bladder 
and uterus and the walls of the arteries and veins, etc. 
When viewed under the microscope, the muscle is 
seen to be composed of many fibrils. The sheath cover- 
ing each fibril is called the sarcolemma, and contains 
within its boundaries the muscle plasma, or protoplasm, 
and a nucleus. Many of the fibrils when grouped to- 
gether constitute the entire muscle. 

The muscles get their blood supply from the nutri- 
ent artery, which ramifies the tissues, the smallest cap- 
illaries coming in contact with each muscle cell. 




Fig. 7— View of 
muscle fibers. 



HISTOLOGY 55 

Tendons. — Tendons are white, glistening, fibrous 
cords, varying in length and thickness, sometimes round, 
sometimes flattened, of considerable strength, and de- 
void of elasticity. It consists principally of a substance 
which yields gelatin. 

Tendons do not have a direct blood supply. 

Aponeuroses. — Aponeuroses are flattened or ribbon- 
like tendons, of a pearly-white color, irridescent, glisten- 
ing, and similar in structure to the tendons. 

Ligaments. — Ligaments consist of bands of various 
forms, serving to connect the articular extremities of 
bones. They are strong bands of smooth, silverwhite 
fibrous tissue. 

A ligament is pliable and flexible, so as to allow the 
most perfect freedom of movement, but at the same 
time it is tough and strong, so as not to yield readily un- 
der the severe applied force, and for this reason they 
serve as good connecting links for the binding of bones 
together. 

Poupart's Ligament. — Poupart's ligament extends 
from the crest of the ilium to the top of the pubic Done. 
This ligament is of utmost importance to the embalmer, 
as it serves as a guide to locate the femoral artery. By 
placing the thumb on the crest of the ilium and the sec- 
ond finger on the top of the public bone, then letting 
the first finger drop midway between the two, which 
would be the center of Poupart's ligament, we have a 
point which marks the exit of the artery from the body 
and the beginning of the femoral artery. 



56 HISTOLOGY 

Poupart's ligament also forms the base of Scarpa's 
triangle. The structure of this triangle will be taken 
up later. 

Fat.— Fat is a deposit of an oil in the cells of the tis- 
sues, just beneath the skin, giving roundness and plump- 
ness to the body, and acting as an excellent non-conduc- 
tor for the retention of heat. 

So tiny are these cells, that there are over sixty-five 
million in a cubic inch of fat. As they are kept moist, 
the liquid does not ooze out ;' but, on drying, it comes to 
the surface, and thus a piece of fat feels oily when ex- 
posed to the air. The quantity of fat varies with the 
state of nutrition. In corpulent persons, the masses of 
fat beneath the skin, in the mesentery, on the surface of 
the heart and the great vessels, between the muscles, and 
in the neighborhood of the nerves, are considerably in- 
creased. Conversely, in the emaciated we sometimes find 
beneath the skin cells which contain only one oil drop. 
Many masses of fat which have an important relation 
to muscular actions — such as the fat of the orbit or the 
cheek, do not disappear in the most emaciated persons. 
Even in starvation, the fatty substance of the brain and 
spinal cord are retained. 

Fat collects as pads in the hollows of the bones, 
around the joints and between the muscles, causing them 
to glide more easily upon each other. As marrow, it 
nourishes the skeleton, and also distributes the shock of 
any jar the limb may sustain. 

Fat does not gather within the cranium, the lungs 



HISTOLOGY 57 

or the eyelids, where its accumulation would clog the 
organs. 

Mucous Membranes. — Mucous membranes line all the 
open cavities of the body, or all those cavities which com- 
municate with the outside. 

At the edges of the openings into the body, the skin 
seems to stop and give place to a tissue which is redder, 
more sensitive, more liable to bleed, and is moistened by 
a fluid or mucous, as it is called. Really, however, the 
skin does not cease, but passes into a more delicate cov- 
ering of the same general structure, and it is to this 
that the name mucous membrane is applied. 

The entire alimentary canal, the entire respiratory 
tract, and the genito-urinary tract, are lined with a mu- 
cous membrane. Mucous membrane secretes a mucous 
fluid. 

Serous Membranes. — Serous membranes line the clos- 
ed cavities of the body. The pleurae, the pericardium 
and the peritoneum are examples of serous membranes. 
Serous membranes secrete a serous fluid. 

Synovial Membranes. — Synovial membranes are se- 
rous in character, and consist of loose connective tissue, 
containing fat, vessels and nerves, its inner surface being 
usually lined with secreting cells. The fluid secreted is 
yellowish-white or slightly reddish, resembling very much 
the white of an egg. It contains fats, salts, albumen, 
extractives from the lymph, and a fluid known as syn- 
ovia. The chief function of this fluid is to act as an oil 
to lubricate the joints and surfaces in which there is any 
friction. 



58 



HISTOLOGY 



Synovial membranes are divided into three classes, 
known as articular, bursal and vaginal. 

Articular synovial membranes are found in every 
free movable joint. 

Bursal synovial membranes are sacs interposed be- 
tween the surfaces which move upon each other, pro- 
ducing friction, as in the gliding of a tendon or of the 
integument over projecting bony surfaces. 

Vaginal synovial membranes serve to facilitate the 
gliding of a tendon in the bony canal through which it 
passes. 

Arteries. — The arteries are cylindrical vessels which 
serve to convey the blood from both ventricles of the 
heart to every part of the body. They are called arte- 
ries from the Greek words which mean 
"to contain air," and they were sup- 
posed, by our ancients, to have this 
function until the time of Galen, when 
he refuted this opinion and showed that 
these vessels, though for the most part 
empty after death, actually contained 
blood. The distribution of the arteries 
may "be compared to a tree, the common 
trunk of which corresponds to the aor- 
ta, and the smallest twigs correspond- 
ing to the minute capillaries. When 
one artery communicates with an- 
other it is said to anastomose, and 
this communication is very free be- 
tween the larger as between the smaller branches. 




Fig. 8— Section of 
artery. ( Grunstein ) 



HISTOLOGY 59 

Anastomosis between trunks of equal size is found where 
great activity of the circulation is requisite, as at the 
base of the brain, where the two vertebrals unite to 
form the basilar artery. 

In the limbs and arms the anastomoses are more nu- 
merous and of larger size around the joints. The branches 
of the artery above, unite with branches, from the ves- 
sels below. These anastomoses are called collateral cir- 
culations. The principal ones of interest to the em- 
balmer are those of the deep brachial uniting with the 
recurrent radial and ulnar arteries, forming the collat- 
eral circulation in the arm; the deep femoral uniting 
with the recurrent posterior and anterior tibials, form- 
ing the collateral circulation in the leg; the superficial 
and deep mammary arteries, branches of the subclavian 
artery uniting with the superficial and deep epigastric 
arteries, branches of the external iliac, forming the col- 
lateral circulation over the abdomen and chest, and may 
be considered the longest collateral circulation in the 
body. 

A terminal artery is one which forms no anastomoses ; 
such vessels are found in the heart, brain, spleen, kidneys, 
lungs and mesentery. 

Structure. — An artery consists of an internal, a mid- 
dle and an external coat. 

The inner coat consists of endothelial cells and elastic 
fibrous tissue, sometimes arranged longitudinally, but 
usually they form a distinct fenestrated membrane (sim- 
ilar to a doorscreen). 



60 



HISTOLOGY 



The middle coat consists mostly of elastic tissue and 
white fibrous tissue. 

The external coat is called the fibrous coat. It con- 
tains fibrous connective tissue and elastic tissues. 

Vasa-Vasorum. — Running in the outer wall of the 
artery, we find small capillary vessels, and their func- 
tion is that of nourishing the outer wall, for the blood 
which passes through the artery does not nourish the 
artery from within, but depends on these small capil- 
laries, called vasa-vasorum, for their nutrition. 

The individual sheath, or arterial sheath, the cover- 
ing for the artery, is composed of connective tissue, and 
at places may adhere very tightly to the artery. 

Veins. — The veins are the vessels which carry the 
blood from the capillaries back to the right auricle of 





Fig. 9 — Valves of the veins. 



Fig. 10 — Cross section through a small artery 
and vein. (Klein and Noble Smith) 



Fig. 10 



the heart, and are found in nearly every tissue of the 
body. They commence as venous capillaries, uniting 
together into larger and larger veins, until we have the 



HISTOLOGY 



61 



great ascending and descending venae cavae. In form the 
veins are perfectly cylindrical, like the arteries, but with 
this difference, that their walls collapse when empty and 
that they contain valves. 

Structure. — The vein has about the same structure 
as the artery, only that the middle coat is much thinner 
and less elastic than the artery, and for this reason it 
easily collapses. 

Veins are divided into superficial, deep and sinuses. 
Superficial veins are found between the layers of the 
superficial fascia, just underneath the skin. 

Deep veins accompany the arteries, and are usually 
enclosed in the same common sheath with the artery. 

Sinuses are venous channels, which in their structure 
and mode of distribution differ altogether from the veins. 
They are found only in the interior of the skull, and con- 
sist of channels formed by a separation of the two layers 
of the dura mater. 

Blood.— The blood of the body is 
contained in a practically closed sys- 
tem of tubes, the blood vessels, within 
which it is kept circulating by force 
of the heart beat. It is usually spoken 
of as the nutritive liquid of the body, 
but the functions may be stated ex- 
plicitly, although still in quite general 
terms, by saying that it carries to the 
tissues food stuffs after they have been 
properly prepared by the digestive organs ; that it trans- 
ports to the tissues oxygen, absorbed from the air by the 




Fig. 11— Human blood. 



62 HISTOLOGY i 

lungs; that it carries from the tissues various waste pro- 
ducts formed in the processes of dissimilation; that it is 
the medium for the transmission of the internal secretion 
of certain glands; that it aids in equalizing the tempera- 
ture and water contents of the body. 

The total quantity of blood in the body has been de- 
termined approximately for man as one-thirteenth of the 
body weight. The specific gravity of human blood in 
the adult may vary from 1.041 to 1.067, the average be- 
ing about 1.055. 

The blood is composed of a liquid part, the plasma, 
in which float a vast number of microscopical bodies, the 
blood corpuscles, known respectively as the red corpus- 
cles, the white corpuscles or leucocytes, of which in turn 
there are a great many different kinds, and the blood 
plates. 

Blood plasma, when obtained free from corpuscles, is 
perfectly colorless, in thin layers, for example, in micro- 
scopical preparation; when seen in large quantities it 
shows a slightly yellowish tint. The red color of the 
blood is not due, therefore, to coloration of the blood 
plasma, but is caused by the mass of red corpuscles held 
in suspension in the liquid. The proportion by bulk of 
plasma to corpuscles is usually given roughly as two to 
one. The blood plasma is composed of two substances, 
blood serum and blood fibrin. You have noticed that 
blood, after it has escaped from the vessels, usually clots 
or coagulates. The clot, as it forms, gradually shrinks 
and squeezes out a clear liquid, to which the name blood 
serum has been given. Serum resembles the plasma of 



HISTOLOGY 63 

normal blood in general appearance, but differs from it 
in composition. Here it is sufficient to say that blood 
serum is the liquid part of the blood after coagulation 
has taken place. You can prepare this experiment for 
yourself: If shed blood is whipped vigorously with a rod 
or some similar object while it is clotting, the essential 
part of the clot, namely the fibrin, forms differently from 
what it does when the blood is allowed to coagulate 
quietly. It is deposited in shreds on the whipper. Blood 
that has been treated in this way is known as defibrin- 
ated blood. It consists of blood serum plus the red and 
white corpuscles, and as far as appearances go it resem- 
bles exactly the normal blood; it has lost, however, its 
power of clotting. 

Red blood corpuscles are bi-concave, circular disks, 
without nuclei; their average diameter is 7.7 microns (1 
micron equals 1-25,000 of an inch) ; their number, which 
is usually reckoned as so many to a cu. millimeter, varies 
greatly under different conditions of health and disease. 
The average number is given as 5,600,000 per cubic milli- 
meter for males and 4,500,000 per cubic millimeter for 
females. 

The number of red corpuscles also varies in individ- 
uals with the constitution, nutrition and manner of life. 
It varies with age, being greatest in the fetus and in 
the new-born child. It varies with the time of the day, 
showing a distinct diminution after meals. In the female 
it varies somewhat with menstruation and pregnancy, 
being slightly increased in the former and diminished in 
the latter condition. 



64 HISTOLOGY 

The red color of the corpuscles is due to the presence 
in them of a pigment, known as hemoglobin. Owing to 
the minute size of the corpuscles, their color when seen 
singly under the microscope is a faint yellowish red, but 
when seen in mass they exhibit the well-known blood-red 
color, which varies from a scarlet in arterial blood to a 
purplish red in venous blood, this variation in color be- 
ing dependent upon the amount of oxygen contained in 
the blood in combination with the hemoglobin. The 
function of the red blood corpuscles is to carry oxygen 
from the lungs to the tissues. This function is entirely 
dependent upon the presence of hemoglobins, which have 
the power of combining easily with the oxygen gas. 

White blood corpuscles or leucocytes contain no hem- 
oglobin or coloring matter. They have a nucleus or cen- 
ter spot. Their size varies from 5 to 12 microns, and are 
less numerous than the red corpuscles, being in this pro- 
portion: one white corpuscle to 500 red corpuscles. The 
chief functions of the white corpuscles are: (1) That they 
protect the body from pathogenic or disease-producing 
bacteria. In explanation of -this action it has been sug- 
gested that they may either ingest the bacteria and thus 
destroy them directly, or they may form certain sub- 
stances, defensive proteids, that destroy the bacteria. 
White corpuscles that act by ingesting the bacteria are 
spoken of as phagocytes (meaning to eat the cell). (2) 
They aid in the absorption of fats from the intestines. 
(3) They aid in the absorption of peptones from the in- 
testines. (4) They take part in the process of blood 
coagulation. (5) They help in maintaining the normal 
composition of the blood plasma in proteids. 



HISTOLOGY 65 

Blood plates are small circular or elliptical bodies, 
nearly homogeneous in structure, variable in size, always 
much smaller than the red blood corpuscles. Less is 
known of their origin, fate and functions than in the 
case of the other blood corpuscles, but there is some con- 
siderable evidence to show that they take part in the 
process of coagulation or clotting. 

Coagulation of the Blood. — One of the most striking 
properties of the blood is its power of clotting, or coag- 
ulating, shortly after it leaves the blood-vessels, or if 
any foreign elements come in contact with it. The gen- 
eral changes in the blood during this process are easily 
followed. At first perfectly fluid, in a few minutes it 
becomes viscous, and then sets into a soft jelly, which 
quickly becomes firmer, so that the vessel containing it 
can be inverted without spilling the blood. The clot con- 
tinues to grow more impact, and gradually shrinks in 
volume, pressing out a greater or smaller amount of 
clear, faintly yellow liquid, to which the name blood se- 
rum is given. The essential part of the clot is the fibrin. 

Fibrin is an insoluble proteid not found in normal 
blood. In shed blood, and under certain conditions while 
still in the blood-vessels, this fibrin is formed. In form- 
ing, it shows an exceedingly fine network of delicate 
threads that permeate the whole mass of the blood and 
gives the clot its jelly-like character. The shrinking of 
the threads causes the subsequent contraction of the 
clot. If the blood has not been disturbed during the 
act of clotting, the red corpuscles are caught in the fine 
fibrin mesh-work, and as the clot shrinks these corpuscles 



66 HISTOLOGY 

are held more firmly, only the clear liquid of the blood 
being squeezed out, so it is possible to get specimens of 
serum containing few or no red blood corpuscles. The 
white corpuscles or leucocytes, on the contrary, although 
they are also caught at first in the forming meshes of 
fibrin, in latter stages of the clotting they readily pass 
out into the serum, on account of their power of having 
movement. If the blood has been agitated during the 
process of clotting, the delicate net work will be broken 
in places, and the serum will be more or less bloody — that 
is, it will contain numerous red blood corpuscles. If 
during the time of clotting the blood is vigorously whipp- 
ed with a bundle of fine rods, all the fibrin is deposited 
as a stringy mass on the whipper, and the remaining li- 
quid part consists of serum plus red corpuscles. Blood 
that has been whipped in this way is known as defibrin- 
ated blood. It resembles normal blood in appearance, 
but is different in composition it can not clot again. The 
way in which fibrin is normally deposited can be easily 
demonstrated by taking a drop of blood on a slide and 
covering it with a cover slip, allow it to stand several 
minutes until coagulation is complete, and view under a 
microscope. If the drop is examined, it is possible by 
careful focusing, to discover in the spaces between the 
masses of corpuscles many examples of delicate fibrin 
net work. The physiological value of the clotting of blood 
in life is that it stops hemorrhages by closing the open- 
ings of the wounded blood vessels, but the clotting of the 
blood after death, is to the embalmer one of the bug- 
bears, and a real method of preventing it, or of dissolving 



HISTOLOGY 67 

the clot after it has once formed in the blood vessels is 
one of those difficult problems which remains as yet un- 
solved. 

Since we have no real method of preventing coagula- 
tion in the blood vessels, let us search out the things 
which will hasten or retard this coagulation. Blood 
coagulates normally within a few minutes after it is 
liberated from the blood vessel, but this process may 
be hastened by increasing the amount of foreign sub- 
stance with which it comes in contact. Thus the agita- 
tion of the liquid in quantity or the application of a 
sponge or handkerchief or the application of heat hastens 
the onset of clotting. 

Coagulation in drawn blood may be retarded or pre- 
vented altogether by a variety of means, of which the 
following are the most important: 

(1) By cooling. 

(2) By the action of neutral salts. 

(3) By the action of oxalate solutions. 

(4) By the action of sodium fluoride. 
Summary. — To summarize then, the following state- 
ments may be made : 

(1) The immediate factor necessary to the clotting 
of the blood is the fibrin. 

(2) That blood does not clot normally in the blood 
vessels before death. 

(3) That after death blood remains for a long time 
without clotting, provided some outside agent is not 
introduced to cause it. 

Such an agent may be the blood coming in contact 
with the air, or the blood drainage tube. The one point 



68 HISTOLOGY 

then to be emphasized is that when a vein is cut, and the 
blood begins to flow, you know that the blood is not in a 
coagulated condition. Then work rapidly, put the blood 
drainage tube quickly into the vein and draw off as much 
blood as you can before it begins to clot at the end of 
the tube. The great trouble has been, that the embalmer 
does not work with precision. He first raises the vein, 
and exposes it on the surface of the incision. He then 
raises the artery. He places the drainage tube into the 
vein, but shuts it off till he is ready with the artery. 
Now, by the time he has placed the arterial tube in the 
artery, injected a few bulbs full to see that all is in 
working order, and has perhaps attended to a few other 
duties, he is amazed to find that the blood will not flow, 
that it has clotted. What is the reason? He gave it 
time to clot after the drainage tube was inserted. 

A better procedure would be not to touch the vein 
until every other procedure has been attended to. Then 
raise the vein, insert the drainage tube and withdraw 
the blood quickly, and at the same time keep injecting 
slowly into the arterial system to keep up the needed 
pressure to keep the blood flowing. 

(4) That when a clot is once formed in a blood vessel, 
it is not dissolved by the addition of fluid or any other 
solution. 

(5) That sometimes when the blood has become 
clotted at the end of the drainage tube, it can be loosened 
up or be slightly pushed away by attaching the pump 
to the drainage tube and injecting a few bulbs of fluid, 
which, when it runs out, will again start the flow of 
blood. 



CHAPTER V. 



OSTEOLOGY. 



Definition. — Osteology is the science of the structure 
and functions of bones. 

In regard to the treatment of this subject, it is not 
our aim to take up all the minute details concerning each 
bone, all we desire is to explain the form, uses and lo- 
cation of some of the principle bones and sets of bones 
of the body in so far as they may come to be used as 
landmarks for the embalmer. 

The Skeleton. — The entire skeleton in the adult con- 
sists of 200 distinct bones. 




Fig. 12— The Skeleton. 



69 



70 OSTEOLOGY 

Spine — 

Cervical 7 

Dorsal 12 

Lumbar 5 

Coccygeal 1 

Sacrel 1 

26 26 

Cranium 8 

Face 14 

Hyoid 1 

Sternum 1 

Ribs- 
True 7 Pair 

False 3 " 

Floating 2 



a 



12 " 24 

Upper Extremities 64 

Lower Extremities 62 



200 



In the above outline the bones of the ear and the 
sesamoid bones are not considered. Different anatomists 
make different computations as to the number of bones 
in the skeleton. Some authorities add the bones of the 
ear, thus making 206 in all. If all the little sesamoid 
bones were added, the number could be greatly aug- 
mented. 



OSTEOLOGY 



71 



The Vertebral or Spinal Column. (The Spine). — The 

spine is a flexuous and flexible column formed of a series 
of bones called vertebrae. There are twenty-six in num- 
ber and may be divided as follows : 

Cervical 7 bones 

Dorsal 12 " 

im&M Lumbar 5 

Sacral 1 

,, Coccygeal 1 

mm ^ ne cerv i ca l vertebrae are smaller 

than those in any other region of the 
spine, and may be readily distinguished 
as they lie in the neck and extend from 
the base of the skull to the dorsal ver- 
tebrae, or the point of attachment of 
'S&M the first rib to the first dorsal. 

V$79§^ ^e dorsal or thoracic vertebrae are 

wfi&mL ^ e nex t in rotation down the spine and 

are intermediate in size between those 

y$M in the cervical and those m the lumbar 
IMiB 
V*j|p» region, and increase in size from above 

downward. 

The lumbar vertebrae, the next in 
rotation, are the largest of the verte- 
bral column and can be distinguished 
7 * as those lying in the lumbar region or 

the small of the back. 

The sacrum, meaning sacred, so 
called, because it was the part selected 
Fig. 13-The Spine. * n sacrifices. The sacrum is a large 



72 OSTEOLOGY 

triangular bone, situated at the lower part of the verte- 
bral column, and at the upper and back part of the pel- 
vic cavity. 

The coccyx, so called from having been compared to 
a cuckoo's beak. It is usually formed of four small seg- 
ments of bones, and gradually diminish in size from above 
downward, and blend together so as to form a single 
bone. 

The spinal column is situated in the median line, 
at the posterior part of the trunk. Its average length 
is about two feet, two or three inches. The female spine 
is about one inch shorter than the male. 

The spinal canal in which runs the spinal cord, fol- 
lows the different curves of the spine ; the opening being 
the largest in those regions in which the spine enjoys the 
greatest freedom of movement, and the smallest where 
motion is more limited. 

The Skull. — The skull is the bony framework of the 
head. The cranium is the name applied when we do 
not consider the mandible (the lower jaw). . 

The skull is oval in shape, wider behind than in front, 
and is supported on the summit of the vertebral column. 

The skull is composed of twenty-two bones and is 
divided as the following diagram will show: 



OSTEOLOGY 



73 




Fig. 14- The Skull. 



Cranium 



Occipital 

Two parietal 

Frontal 

Two temporal 

Sphenoid 

Ethmoid 



Skull 



Face 



Two inferior turbinate 

Two nasal 

Two superior maxillary 

Two larchrymal 

Two malar 

Two palate 

Inferior maxillary 

Vomer 



74 OSTEOLOGY 

The Bones of the Cranium. — Occipital Bone. — The 
occipital bone is situated at the back part and base of 
the cranium. 

Frontal Bone. — The frontal bone is situated at the 
anterior part of the cranium, and forms the forehead. 

Parietal Bones. — The parietal bones, two in number, 
form, by their union, the sides and roof of the cranium. 
They are between the frontal and the occipital bones. 

Temporal Bones. — The temporal bones, two in num- 
ber, are situated at the sides and base of the skull. 

Sphenoid Bone. — The sphenoid bone is situated at 
the anterior part of the base of the skull articulating with 
all the other cranial bones. 

Ethmoid Bone. — The ethmoid is an exceedingly light, 
spongy bone, which is situated at the anterior part of 
the base of the cranium. 

The Bones of the Face. — Nasal Bone. — The nasal 
bones, two in number, are placed side by side at the mid- 
dle and upper part of the face, forming, by their junction, 
"the bridge" of the nose. 

Superior Maxillary Bones. — The superior maxillae, 
two in number, are the largest bones of the face, except- 
ing the lower jaw, and form by their junction, the upper 
jaw. 

Inferior Maxillary Bone. — The inferior maxillary 
bone is also called the mandible. This bone is the largest 
and strongest bone of the face. In a great many cases 
after death this bone drops down, and it becomes one 
of the first duties of the embalmer, to place this bone 
in the proper position, so that it will set with the gradual 



OSTEOLOGY 75 

death stiffening. If the lower jaw has already set, in 
proper position, it is best not to break up the rigor, be- 
cause, once broken up, it will be hard to set it in proper 
condition again without the use of stitches. 

The upper and lower jaws are the fundamental bones 
for mastication. 

Lachrymal Bones. — The lachrymal bones, two in num- 
ber, are the smallest and most fragile bones of the face. 
They are situated at the front part of the inner wall of 
the orbit of the eye. 

Malar Bones. — These are the cheek bones. There are 
two in number, situated at the upper and outer part of 
the face. 

Palate Bones. — The palate bones, two in number are 
situated at the back part of the nasal fossae. Each bone 
assists in the formation of three cavities: the floor and 
the outer wall of the nose, the roof of the mouth, and 
the floor of the orbit. 

Inferior Turbinated Bones. — The inferior turbinated 
bones are situated one on each side of the outer wall of 
the nasal fossae. 

Vomer. — The vomer, a single bone, is situated ver- 
tically at the back part of the nasal fossae, forming part 
of the septum of the nose. It is thin and somewhat like 
a ploughshare in form. 

The Hyoid Bone. — The hyoid bone is named from its 
resemblance to the Greek letter U. It is also called the 
lingual bone, because it supports the tongue and gives 
attachment to its numerous muscles. 

The omo-hyoid muscle, which crosses the carotid 



76 OSTEOLOGY 

artery at its middle third, has its insertion with the hyoid 
bone. 

The Bones of the Thorax.— The Sternum or Breast 
Bone. — The sternum is a flat, narrow bone, situated in the 
median line of the front of the chest. The lower end is 
called the ensiform process, to which the diaphragm has 
its anterior attachment. 

The Ribs. — The ribs, which are curved arches of bone, 
form the chief part of the thoracic walls. There are 
twelve in number on each side, although this number 
may vary. 

The ribs are divided into seven pairs of true ribs, 
three pairs of false ribs, and two pairs of floating ribs, as 
the following outline will show: 

Ribs 
7 true 
3 false 
2 floating 

12 pairs in all. 

The true ribs are connected behind to the spine and 
in front to the sternum. 

The false ribs are connected behind to the spine, but 
are called false because they are not attached directly to 
the sternum, but indirectly, the cartilages attaching to 
the cartilage of the rib next above. 

The floating ribs are so named because they are only 
attached at one place, which is the spine and are loose 
or float in front. 



OSTEOLOGY 77 

The Bones of the Upper Extremities. — The Shoulder 
girdle consists of the clavicle and scapula. 

The Clavicle. — The clavicle or key bone, so-called be- 
cause of its supposed resemblance to the key used by the 
Romans, forms the anterior portion of the shoulder girdle. 
It is often commonly called the collar bone. 

The Scapula. — The scapula comes from a Greek word 
meaning "a spade." It forms the back part of the shoul- 
der girdle. 

The arm is that portion of the upper extremity which 
is situated between the shoulder and the elbow. 

The Humerus. — This is the largest and strongest 
bone of the upper extremity and is found in the arm be- 
tween the shoulder and the elbow. It is the only bone 
in the arm. 

The fore arm is that portion of the upper extremity 
which is situated between the elbow and the wrist. The 
fore arm has two bones, the ulna and the radius. 

The Ulna. — A long thin bone, but larger than the 
radius, and situated on the inside of the fore arm. 

The Radius. — So-called because it is the rotary bone 
of the fore arm. It is situated on the outside of the fore 
arm and parallel with the ulna. 

The hand is .subdivided into the wrist or carpus 
bones, the metacarpus or the bones of the palm, and the 
phalanges or the bones of the digits. There are twenty- 
seven bones in each hand. 

The Bones of the Lower Extremities. — The bones of 
the lower extremities consist of the pelvic girdle, the 
thigh, the leg and the foot. 



78 OSTEOLOGY 

The pelvic girdle consists of three portions, the 
ilium, the pubis, and the ischium. 

The Ilium. — The ilium is the superior, broad and ex- 
panded portion and forms the prominence of the hip. 
The top part is called the crest. 

The Ischium. — The ischium is the lowest portion of 
the girdle, and is the portion which supports the body 
when in a sitting position. 

The Pubis. — This bone forms the front of the pelvis, 
and supports the external organs of generation. 

The thigh is that portion of the lower extremity which 
is situated between the pelvis and the knee. It consists 
of a single bone called the femur. 

The Femur. — The femur is the largest, longest and 
strongest bone in the skeleton. It is almost perfectly 
cylindrical. It extends from the hip to the knee. 

The bones of the leg are three in number and are as 
follows : patella, tibia, and fibula. 

The Patella. — This bone is often called the knee cap 
or the knee pan. It is a flat triangular bone, situated at 
the anterior part of the knee joint. 

The Tibia. — The tibia is situated at the front and in- 
ner side of the leg, and is next to the femur in strength 
and size. It is sometimes called the shin bone. 

The Fibula. — The fibula is sometimes called the calf 
bone. It is situated at the outer side of the leg, and is a 
quite slender bone. 

The foot is divided into the tarsus, metatarus, and 
the phalanges. There are seven tarsus bones, five metatar- 
sus bones, and fourteen phalanges bones, making a total 
of twenty-six bones for each foot. 



CHAPTER VI. 

ORGANOLOGY. 

The body itself is divided into the upper and the 
lower extremities and the trunk. The upper extremities 
consist of the head and arms. The lower extremities 
consist of the legs. The trunk is that part of the body 
remaining after the head, arms, and legs have been 
severed from the body. 

The Cavities. — The body has three principal cavities : 
namely, the cerebro-spinal, the thoracic, and the abdom- 
inal. 

The Cerebro-Spinal Cavity. — The cerebro-spinal cavity 
is formed by the cranial bones, and the vertebral column. 
The cerebro-spinal cavity is divided into the sub-cavities, 
called the cranial cavity and the spinal cavity. 

In the cranial cavity we find the brain. The brain 
is the seat of the mind, and the functions which the 
brain performs distinguishes man from the other animals,, 
as man becomes a conscious, intelligent, responsible being 
through the action of the brain. The brain is egg- 
shaped, soft and yielding, closely fitting the cranial cavity. 
The front and top of the brain is called the cerebrum, 
which is the center for intelligence, reason, and will. This 
part of the brain is convoluted, and the depth of the 
convolutions to a great extent indicates the amount of 
intelligence. 79 



80 



ORGANOLOGY 



Below the cerebrum and lying in front of the occipi- 
tal bone, we find the cerebellum, which is the seat of 
memory and the center for the co-ordination of muscle 
movements. By co-ordination of muscle movement is 
meant that the muscles will do just what we want them 
to do, that they will act harmoniously, the one with the 
other. The condition of Saint Vitus' Dance would be an 
example showing a lack of co-ordination. This part of 
the brain is also convoluted. 

Between the cerebrum and the 
cerebellum, and connecting the 
two, is found the pons Varolii. 
The word pons means bridge, and 
the word Varolii means to cross 
over. It is in this part of the 
brain, then, that the nerve fibers 
cross over to the opposite side. 
A person having a paralytic stroke 
on the right side of the body 
would indicate that the left side 
of the brain had become affected. 
Joined to this is the medulla ob- 
longata. This is the lowest part 
of the brain and is the connecting 
link between the brain and the 
spinal cord. The medulla controls 
the circulation, respiration, and 
deglutition (swallowing). 
Closely adhering to the brain, is a delicate membrane, 
sinking into the convolutions, and following the surface 
of the brain valleys throughout. This membrane is called 




Fig. 15 



Brain and spinal 
cord. 



ORGANOLOGY 81 

the pia mater. In it is found the capillaries,, which sup- 
ply the brain with its nutritive blood in life and with em- 
balming fluid after death. These capillaries do not pen- 
etrate the substance of the brain, but the process is one 
of osmosis, absorption or transfusion. Covering the outer 
most part of the brain, and closely adhering to the cranial 
bones is a dense, tough, glistening, membrane, called the 
dura mater. In the dura mater is found the sinuses of 
the brain. 

In between the pia mater and the dura mater is a deli- 
cate double membrane forming a closed sack, called the 
arachnoid membrane. This sac contains a serous fluid, 
which offers great protection to the brain. These same 
three membranes also cover the spinal cord, and are 
called all together the meninges of the brain and cord. 

The brain is composed of white and gray matter. The 
gray matter is on the outside, and the white matter is on 
the inside. 

The spinal cavity is formed by the bones of the verte- 
bral column. In this spinal cavity is found the spinal 
cord. It is cylindrical and usually about seventeen inches 
in length, and extends from the medulla oblongata, to 
the lower border of the first lumbar vertebra, where it 
terminates in a slender filament of gray substance. 

There originate from the under surface of the brain 
twelve pairs of nerves, as follows: 

1. Olfactory 

2. Optic 

3. Motor Oculi 

4. Trochlear. 



82 ORGANOLOGY 

5. Trigeminal 

6. Ab due ens. 

7. Facial 

8. Auditory 

9. Glossopharyngeal. 

10. Pneumogastric 

11. Spinal accessory 

12. Hypoglossal 

There originate from the cord thirty-one pairs of 
nerves, as follows : 

Cervical region 8 pairs. 

Thoracic region 12 " 

Lumbar region 5 " 

Sacral region 5 " 

Coccygeal region 1 " ■ 

31 " 

The circulation of the blood through the brain will be 
taken up later. 



CHAPTER VII. 

ORGANOLOGY.— Continued. 

The Thoracic Cavity. — The thorax, or chest is a bony, 
Cartilaginous cage. It contains and protects the prin- 
ciple organs of respiration and circulation. 

The thorax is bounded in front by the sternum and 
costal cartilages, behind by the twelve dorsal vertebrae 
and the posterior parts of the ribs, on the sides by the 
ribs, above by the root of the neck and below by the 
diaphragm, 




Fig. 16 — Front view of the thorax. (Gray) 

In the female the thorax differs as follows from the 
male: Its general capacity is less, the sternum is shorter, 
and the upper ribs are more movable and so allow a 
greater enlargement of the upper part of the thorax than 
the male. 83 



84 ORGANOLOGY 

The capacity of the cavity of the thorax does not cor- 
respond with its apparent size externally, because, (1) 
the space enclosed by the lower ribs is occupied by some 
of the abdominal viscera; and (2) the cavity extends 
above the first rib into the neck. The size of the cavity 
of the thorax is constantly varying during life, with 
the movements of the ribs and diaphragm, and with the 
degree of distention of the abdominal viscera. 

From the collapsed state of the lungs, as seen when 
the thorax is opened, in the dead body, it would appear 
as if the viscera only partly filled the cavity of the thorax, 
but during life there is no vacant space, that which is 
seen after death being filled up during life by the ex- 
panded lungs. 

Larynx. — The larynx is the organ of voice, placed at 
the upper part of the air passage. It is situated between 
the trachea and the base of the tongue, at the upper and 
forepart of the neck, where it forms a considerable pro- 
jection in the middle line. It is for this reason that 
it is of considerable importance to embalmers, for it is 
just opposite this projection, on either side of the neck, 
that the common carotid divides into the internal and 
the external carotid. 

On either side of it lie the great blood vessels of the 
neck, behind it forms a part of the boundary of the 
pharynx, and is covered by the mucous membrane lining 
that cavity. 

Its vertical extent corresponds to the fourth, fifth, 
and sixth cervical vertebrae. It is placed somewhat 
higher in the female than in the male. 



ORGANOLOGY 85 

The movements of the head affect the position of the 
larynx. When the head is drawn back, the larynx is 
lifted, and when the chin approaches the chest the larynx 
is depressed. During swallowing the larynx moves dis- 
tinctly; during singing it moves slightly. 

Until puberty there is no marked difference between 
the larynx of the male and that of the female. In the 
male after puberty all the cartilages increase in size, 
and the larynx becomes prominent as the Adam's apple 
in the middle line of the neck. In the female after 
puberty the increase of size is only slight. 

The larynx is broad above, where it presents a tri- 
angular appearance, flattened behind and at the sides. 
Below it is narrow and cylindrical. 

It is composed of cartilages which are connected 
together by ligaments and moved by numerous muscles. 
It is lined by a mucous membrane which is continuous 
above with the lining of the pharynx and below with 
that of the trachea. 

The arteries that supply the larynx are the laryngeal 
arteries, branches of the superior and inferior thyroid 
arteries. 

The superior laryngeal vein runs into the superior 
thyroid vein and then into the internal jugular vein, 
while the inferior laryngeal vein runs into the inferior 
thyroid vein and then into the innominate vein. 

The Trachea. — The trachea or windpipe is a cartil- 
aginous elastic, cylindrical tube, flattened posteriorly. It 
extends from the lower part of the larynx, on a level 
with the sixth cervical vertebra to opposite the body of 



86 



ORGANOLOGY 



the fourth dorsal, where it divides into two bronchi, one 
for each lung. 




Fig. 17 — The cartilages of the larynx; the trachea and 
bronchi. (Gray) 



The trachea is in the median line of the. body. It 
measures about four and one-half inches in length. The 
diameter is from three quarters to one inch, being always 
greater in the male than in the female. 

The trachea is composed of imperfect cartilage rings, 
not coming quite together in the back. 



ORGANOLOGY 87 

The artery that supplies the trachea is the inferior 
thyroid artery. 

The vein that withdraws the blood is the inferior 
thyroid vein. 

The Right Bronchus. — The right bronchus is shorter, 
and wider than the left bronchus. It is about one inch 
in length. It enters the lung opposite the fifth dorsal 
vertebra. 

The Left Bronchus. — The left bronchus is smaller and 
longer than the right. It is two inches in length and 
enters the lung at a point opposite the body of the sixth 
dorsal vertebra. 

Each bronchus divides into smaller divisions called 
bronchial tubes. 

Each bronchial tube divides into still smaller divi- 
sions called bronchioles. 

Each bronchiole ends in the air cell. 

The Pleurae. — Each lung is invested upon its external 
surface by an exceedingly delicate serous membrane, the 
pleura. This encloses the organ as far as its root, and 
is then reflected upon the inner surface of the thorax. 

The pulmonary pleura is the portion investing the 
surface of the lung, and dipping into the fissures between 
its lobes. 

The parietal pleura is that which lines the inner 
surface of the chest. 

The space between these two layers is called the 
cavity of the pleurae, (the pleural cavity) J and contains 
nothing but a very little clear fluid. 

In the healthy condition the two layers are in con- 



88 ORGANOLOGY - 

tact and there is no real cavity, but after death the lungs 
become collapsed and separate from the walls of the 
chest. Each pleura is therefore a shut sac, one occupy- 
ing the right, and the other the left half of the thorax, 
and they are perfectly separated from one another. The 
two pleurae do not meet in the middle line of the chest, 
excepting for a short distance between the second and 
third pieces of the sternum — a space being left between 
them, which contains all the viscera of the thorax except- 
ing the lungs; this is called the mediastinum. 

The mediastinum then, is the space between the right 
and left pleural sacs. 

The arteries of the pleura are derived from the inter- 
costal, internal mammary, musculo-phrenic, thymic, peri- 
cardiac, bronchial. 

The veins correspond to the arteries. 

The Lungs. — The lungs are the essential organs of 
respiration. They are two in number, placed one on 
each side of the chest, separated from each other by the 
heart and the contents of the mediastinum. A healthy 
lung hangs free within the pulmonary space. The lung 
is suspended by the root. The root of the lung is formed 
by the bronchial tubes, pulmonary artery, pulmonary 
veins, bronchial arteries, bronchial veins, etc., all of which 
are enclosed by the reflections of the pleurae. 

The root of the lung may be described as being that 
part where all the great blood vessels and the bronchial 
tubes, enter the lungs. 

In many cases the lung does not hang free, but as a 



ORGANOLOGY 



89 



result of former pleurisy, the area of the pulmonary 
pleura is adherent to the parietal pleura. 




Fig. 18— The root of the left lung. (Toldtj 



Each lung is conical in shape, and presents for ex- 
amination, an apex, a base, and two surfaces. 

The Apex forms a tapering cone which extends into 
the root of the neck about an inch and a half to two 
inches above the level of the top of the first rib. 

The Base is broad and concave and rests upon the 
convex surface of the diaphragm, which separates the 



90 ORGANOLOGY 

right lung from the upper surface of the right lobe of 
the liver and the left lung from the upper surface of the 
left lobe of the liver, the stomach, and spleen. 

Surfaces. — There are two in number. The external, 
costal or thoracic surface is smooth, convex and corres- 
ponds to the form of the cavity of the chest. The inner 
or mediastinal surface is concave, and the middle por- 
tion, where all the vessels enter and leave the lung is 
called the root. 

Lobes. — Each lung is divided up into lobes. The right 
lung has three lobes, and the left lung has two lobes. 

Weight. — The weight of both lungs together is about 
42 ounces, the right lung being a little heavier than the 
left. The lungs are heavier in the male than in the fe- 
male. The male lungs weigh from 42 to 45 ounces, and 
the female lungs weigh from 32 to 35 ounces. 

Color. — The color of the lungs at birth is a pinkish 
white, in adult life a dark state color, mottled in patches 
and as age advances this mottling assumes a black color. 

Substance. — The substance of the lung is of a light 
porous, spongy texture. It floats in water, if it has once 
been filled with air. It is elastic and for this reason we 
always find the lung collapsed after death. 

The structure of the lung is such that the blood 
brought by the pulmonary artery comes into close re- 
lation with the air in the air-cells which enters from the 
bronchioles. The blood gives off carbon dioxide to the 
air-cells and the air in the cells furnishes oxygen for the 
blood. The process of respiration causes the dark blood 



ORGANOLOGY 91 

brought from the heart by the pulmonary arteries to re- 
turn to the heart as red blood in the pulmonary veins. 

Arteries. — The bronchial arteries supply the lungs 
with nutrition. 

The pulmonary arteries convey venous blood from 
the heart to the lungs to be purified. 

Veins. — The bronchial veins carry off the impure 
blood from the lungs. 

The pulmonary veins convey the blood which has been 
purified by the lungs, back to the heart. 

The Mediastinum. — The mediastinum is the space left 
in the middle portion of the chest by the non-approx- 
imation of the two pleurae. It extends from the sternum 
in front to the spine behind. 

Within it are the contents of the thorax, excepting 
the lungs. The mediastinum may be divided into two 
parts. 

The superior mediastinum is that portion of the in- 
terpleural space which lies above the level of the peri- 
cardium. This space contains the arch of the aorta, in- 
nominate, part of the left carotid artery, part of the left 
subclavian artery, the upper half of the superior vena 
cava, the upper half of the innominate vein, the left 
superior intercostal vein, trachea, esophagus, thoracic 
duct, remains of the thymus gland, etc. 

The inferior mediastinum is divided into three por- 
tions : 

The anterior mediastinum is that portion in front 
of the pericardium. It contains nothing but some loose 
areolar tissue. 



92 ORGANOLOG 

The posterior mediastinum is that portion back 
of the pericardium. It contains the descending thoracic 
aorta, the greater and lesser azygos veins, the esophagus, 
the thoracic duct, etc. 

The middle mediastinum is that part within the 
pericardium or heart sac. It is the largest space of all 
the mediastinal spaces. It contains the heart, the ascend- 
ing aorta, the lower half of the superior vena cava, the 
vena azygos, the bifurcation of the trachea, the pulmon- 
ary artery, etc. 

The middle mediastinum is sometimes called the car- 
diac cavity, because it contains the heart. 

The Pericardium (Heart Sac). — The pericardium is 
a serous sac in which is located the heart and the com- 
mencement of the great blood vessels. 

Behind we find the bronchi, esophagus and descending 
thoracic aorta. To the sides we find the pleura, the 
phrenic nerve and the accompanying vessels. In front 
we find the sternum and the remains of the thymus gland. 
It is attached above to the great blood vessels and below 
to the diaphragm. 

The Heart. — The heart is a hollow, muscular organ 
of a conical (cone shaped) form, placed between the 
lungs and enclosed in the pericardium. 

The heart is placed obliquely in the chest. The base 
is directed upward, backward and to the right, and cor- 
responds to the dorsal vertebrae from the fifth to the 
eighth inclusive. 

The apex is directed downward, forward and to the 
left and corresponds to the space between the cartilages 
between the fifth and sixth ribs. 



ORGANOLOGY 



93 



The exact location of the apex of the heart would be 
^4-inch to the inner side, and an inch and one-half below 
the left nipple, or about three and one-half inches from 
the middle line of the sternum or breast bone. 




Fig. 19 — A cross section of the heart showing valves. (Spalteholz) 



The heart is placed behind the sternum, and extends 
about three inches to the left of the median line, and 
about one and one-half inches to the right, or in other 
words, about one-third of the heart lies to the right of 
the median line, and two-thirds lies to the left of the 
median line. 

The heart in the adult measures five inches in length, 
three and one-half inches in breadth in its broadest part, 
and two and one-half inches in thickness. The weight 



94 



ORGANOLOGY 



of the male heart varies from ten to twelve ounces, and 
that of the female from eight to ten ounces. 

The capacity of the. ventricles of the heart averages 
about three and one-half ounces of blood to each ven- 
tricle, and the auricle a little less than four ounces, 
making the total capacity of the heart average about 
fifteen ounces. 

The heart is divided by a muscular septum (separation 



Foramina, 
Thel 



Tubercle 
If Lower 




Bristle passed thr 
Sight Awrieulo- Ventricular" opening. 

FlG. 20 — The right auricle and ventricle laid open. (Gray) 



ORGANOLOGY 95 

wall) into two lateral halves, which are named respec- 
tively the right or venous side and the left or arterial 
side. The septum is called the longitudinal septum. 
Each side of the heart is further sub-divided into an 
upper and lower compartment, the upper on each side is 
called the auricle and the lower the ventricle. The 
upper and lower compartments of the heart (auricles 
and ventricles) are separated by the auricular- ventric- 
ular septums (meaning a separation between the auricle 
and ventricle). 

The superior and inferior venae cavae empty into the 
right auricle of the heart, also the blood from the cor- 
onary sinus. 

In fact, this compartment receives all the venous 
or impure blood from all parts of the body, and sends 
it through what is known as the tricuspid valve into 
the right ventricle or lower compartment. After getting . 
into the right ventricle, the blood is sent forth into the 
lungs by first passing through the pulmonary semi-lunar 
valve into the pulmonary artery, which enters the lungs 
at the root of the same. 

This would then finish the circulation through the 
right side of the heart, and after the purification has been 
accomplished by the lungs, we find the blood being re- 
turned to the left side of the heart through the four 
pulmonary veins. The pulmonary veins extend from the 
lungs (two on each side) to the left auricle (upper com- 
partment of the heart) and deliver the purified blood 
to the left or arterial side. The course of the blood from 
the left auricle is downward into the left ventricle (or 



96 ORGANOLOGY 

lower compartment) through what is known as the bi- 
cuspid or mitral valve. 

The blood is then sent out into the body to nourish 
all the tissues, by being forced through the aortic semi- 
lunar valve into the great aorta artery. The circulation 
is then completed by the blood running into the branch 
arteries and from them into the smaller branches an,d 
into the capillaries from which the course of the blood 
is into the smaller veins and into the larger veins, finally 
terminating into the two large trunk veins, the ascending 
(or inferior) and descending (or superior) venae cavae. 
Of these two large trunk veins the ascending vena cava 
is the only one to have a valve at its termination (eusta- 
chian). The functions of this valve are to prevent a 
backward flow of blood into the vein from the auricle. 

The heart has three walls, the inner wall is called the 
endocardium, the middle wall is called the myocardium, 
and the outer wall is called the epicardium. 

The heart is surrounded by a serous sac called the 
pericardium. 

The heart receives its blood supply from the coronary 
arteries, which are branches of the ascending aorta, just 
after it leaves the aortic semi-lunar valve. 

The coronary veins bring the venous blood back from 
the tissues of the heart and empty into the coronary 
sinus, back of the right auricle of the heart. 

The veins which originate about the region of the 
right auricle, empty directly into the right auricle of 
the heart through the valves of Thebesii. 

The Alimentary Canal. — The alimentary canal is a 



ORGANOLOGY 97 

muscular membranous tube. It is about thirty feet in 
length, and extends from the mouth to the anus. It is 
lined throughout by a mucous membrane. 

The following outline will show the parts of the ali- 
mentary canal : 

Mouth 
Pharynx 
Oesophagus 
Stomach 

Duodenum 
Small Intestines <J Jejunum 

Ileum 

Caecum 
Large Intestines ^ Colon 

Rectum 

The accessory organs to the alimentary canal are the 
following : 

Teeth, Salivary glands, Liver, Spleen, Pancreas. 

The Mouth. — The mouth is placed at the commence- 
ment of the alimentary canal. It is a nearly oval shaped 
cavity. 

In this cavity the mastication of the food and the in- 
salivation of the food takes place. 

The Teeth. — The structure of the teeth has been con- 
sidered under the head of tissues. 

The Palate. — The palate forms the roof of the mouth. 
It consists of two portions : The hard palate is in front 
and the soft palate is in the back. 



98 



ORGANOLOGY 



The Salivary Glands. — By the term salivary glands 
is usually understood the three chief glands on each side 
of the face. 

The parotid gland is placed near the ear. The sub- 
maxillary gland is placed below the jaw. The sublingual 
gland is placed below the tongue. 

These glands secrete the salival juices which are 
brought into the mouth by three small ducts, where it 
aids in the digestion of the food. The digestive action of 
the saliva is limited to the starchy foods. Its action is 
to change starches into sugars. 

It also fulfills other important functions. By moist- 
ening the food it enables 
us to reduce the mater- 
ial to a consistency suit- 
able for swallowing and 
for manipulation by the 
tongue and other mus- 
cles. The saliva also 
serves as a kind of lu- 
bricator that insures the 
smooth passage along 
oesophageal canal. 

The Pharynx.— The 

pharynx is that part of 

the alimentary canal, 

which is placed behind, 

and communicates with 

FlG. 21 — Passage into trachea and , , , 1 -, 

esophagus; Pharynx. tne nose > ^OUth and 




ORGANOLOGY 99 

larynx. It is a muscular, membranous tube which ex- 
tends from the back of the mouth and under surface of 
the skull to the level of the cricoid cartilage or to a point 
between the fifth and sixth cervical vertebrae. 

The pharynx is about four and one-half inches in 
length. 

Seven openings communicate with it, as follows: 

Two posterior nares, two eustachian tubes, mouth, 
larynx, esophagus. 

The Esophagus. — The esophagus or gullet is a mus- 
cular canal about nine or ten inches in length, extending 
from the pharynx to the stomach. 

It begins at a point between the fifth and sixth cer- 
vical vertebrae and descends along in front of the spine 
through the posterior mediastinal space, passes through 
the diaphragm, and entering the abdomen, terminates in 
the stomach wall at a point opposite the tenth dorsal 
vertebra. 

At its commencement it is placed in the median line 
and gradually inclines to the left as it passes forward to 
the esophageal opening to the diaphragm. 

The esophagus is from one-half to an inch in diameter. 

Arteries. — The arteries which supply the esophagus 
are the esophageal, which are branches from the aorta. 

Veins. — The esophageal veins empty into the ascending 
vena cava. 

The Diaphragm. — The diaphragm (a partition wall) 
is a dense, muscular, fibrous septum, placed obliquely 
across the trunk. It separates the thoracic from the ab- 



100 ORGANOLOGY 

dominal cavity, forming the floor of the thoracic and the 
roof of the abdominal cavity. 

It is attached in front to the ensiform process of the 
sternum, on the sides to the inner surface of the cartil- 
ages and bony portions of six or seven inferior ribs, and 
behind it is attached to the lumbar vertebrae. 

The diaphragm has three openings, as follows: open- 
ing for the esophagus, opening for the aorta, opening for 
the ascending vena cava. 

The diaphragm is the principal muscle of respiration. 

The arteries which supply the diaphragm are the 
phrenic arteries. 

The phrenic veins receive the blood from the dia- 
phragm. 



CHAPTER VIII. 

ORGANOLOGY.— Continued. 

The Abdomen. — The abdomen is the largest cavity in 
the body. It is oval in form, the extremities of the oval 
being directed upward and downward. 

To facilitate description, the abdomen is artificially 
divided into two parts: 

An upper and larger part, the abdomen proper. 

A lower and smaller part, the pelvis. 

These two cavities are not separated from each other, 
but the limit between them is a line drawn around the 
brim of the true pelvis. 

The abdomen proper differs from the other great cavi- 
ties of the body, in being bounded for the most part by 
muscles and fascia. 

It varies in capacity and shape according to the con- 
dition of the viscera which it contains and in addition, it 
varies in form and extent with age and sex. 

Boundaries. — The diaphragm forms the dome over the 
abdomen, the cavity of the abdomen extending high into 
the bony thorax. 

The lower end of the abdomen is limite'd by the bones 
of the pelvis. 

In front and at the sides it is bounded by the lower 
ribs and abdominal muscles. 101 



102 



ORGANOLOGY 



Behind by the vertebral column and muscles. 

Regions. — For convenience of description of the vis- 
cera, the abdomen is artificially divided into nine regions. 
Thus if two circular lines are drawn around the body, 
the one at the extremities of the ninth ribs where they 
join the costal cartilages, and the other around the crest 
of the ileum, the abdominal cavity is divided into three 
zones. 



Limit 




Fig. 22 — The regions of the abdomen and their 
contents. (Gray) 



If two parallel lines are now drawn perpendicular 
upward from the center of Poupart's ligament, each of 
these zones is subdivided into three parts. 

The middle region of the upper zone is called the epi- 
gastric; and the two lateral regions, the right and left 
hypochondriac. The central region of the middle zone is 



ORGANOLOGY 



103 



called the umbilical; and the two lateral regions, the 
right and left lumbar regions. The middle region of the 
lower zone is called the hypogastric ; and the two lateral 
regions are called the right and the left inguinal regions. 
The viscera contained in each of these are as follows: 



Right Hypochondriac 

The greater part of the 
right lobe of the liver, the 
hepatic flexure of the colon 
and part of the right kid- 
ney. 



Right Lumbar 

Ascending colon, part of 
the right kidney and some 
convolutions of the small 
intestines. 



Right Inguinal or Iliac 

The caecum and vermi- 
form appendix and a por- 
tion of the ascending colon. 



Epigastric Region 

The greater part of the 
stomach including both 
cardiac and pyloric orifices, 
the left lobe and part of 
the right lobe of the liver 
and the gall-bladder, the 
pancreas, the duodenum, 
the suprarenal capsules 
and parts of the kidneys. 



Umbilical Region 

The transverse colon, part 
of the great omentum and 
mesentery, transverse part 
of the duodenum and some 
convolutions of the jeju- 
num and ileum and part of 
both kidneys. 



Hypogastric Region 

Convolutions of the small 
intestines, the bladder in 
children and in adults if 
distended, and the uterus 
during pregnancy. 



Left Hypochondriac 

The fundus of the stom- 
ach, the spleen the extrem- 
ity of the pancreas, the 
splenic flexure of the colon 
and part of the left kidney 
and small portion of the 
left lobe of the liver. 



Left Lumbar 

Descending colon, part of 
the omentum, part of the 
left kidney and some con- 
volutions of the small intes- 
tines. 



Left Inguinal or Iliac 

Sigmoid flexure of the 
colon and a portion of the 
descending colon. 



The Stomach. — The stomach is the principal organ of 
digestion. It is the most dilated part of the alimentary- 
canal, and is situated between the termination of the 
esophagus and the commencement of the small intestines. 
It is placed in part immediately behind the anterior wall 
of the abdomen and beneath the diaphragm. 

The lesser curvature of the stomach extends between 
the cardiac and the pyloric orifices along the right border 
of the organ. 



104 ORGANOLOGY 

The greater curvature of the stomach is directed 
to the left, and is four or five times as long as the lesser 
curvature. 

The cardia is the point at which the esophagus enters 
the stomach wall. 




FlG. 23 — The coeliac axis and its branches. (Gray) 

The cardiac orifice is the opening by which the esoph- 
agus communicates with the stomach. It is sometimes 
called the esophageal opening. It is situated on a level 
with the body of the tenth and eleventh dorsal vertebrae. 
It is to the left of and in front of the aorta. On the an- 
terior surface of the body the cardiac orifice corresponds 
to the articulation of the seventh left costal cartilage to 
the sternum. 

The pylorus is the point at which the stomach passes 
into the duodenum. 



ORGANOLOGY - 105 

The pyloric orifice is the opening by means of which 
the stomach communicates with the duodenum. 

This orifice is guarded by the pyloric valve. When 
the stomach is empty the pylorus is situated just to the 
right of the median line of the body on a level with the 
upper border of the first lumbar vertebra. On the an- 
terior surface of the body its position would be indicated 
by a point one inch below the tip of the ensiform process 
and a little to the right. 

The size of the stomach varies considerable in differ- 
ent subjects. The distance between the two orifices is 
from three to six inches. The weight of the stomach is 
about four and one-half ounces. 

The capacity of the adult male stomach is from five 
to eight pints. The stomach of a new born child holds 
about one ounce. 

The stomach is held in place by the attachment of the 
esophagus to the diaphragm and the fixation of the duo- 
denum to the front of the vertebral column. 

The wall of the stomach consists of four coats : serous, 
muscular, areolar, and mucous. 

The glands of the stomach are of three kinds : gastric, 
pyloric, and cardiac. These glands furnish the digestive 
enzymes of the stomach, namely: pepsin, renin, and hy- 
drochloric acid. 

Arteries. — The arteries that supply the stomach are 
the gastric, and branches from the splenic and the hepatic. 

It must be remembered that when a body is arterially 
injected after death, that the fluid only goes to the stom- 
ach walls and there ends in the capillary system. No 



106 ORGANOLOGY 

doubt a little of this fluid will soak through into the 
inside of the stomach, and tend to preserve the contents 
of the stomach, but it must be added that if the stomach 
contains a considerable quantity of food and water, that 
there will not be enough fluid soak through the stomach 
wall to preserve the contents of the stomach and as a 
result gases arise which cause distention of the abdomen 
and perhaps purging from the mouth and nose. As a rule 
then it is safe to say that when we have purging from the 
mouth and nose, with a visable distention of the abdominal 
cavity, indicating gases in the stomach and the intestines 
that fluid has not reached the contents of the stomach and 
the fecal matter of the intestines, and therefore it will be 
necessary to introduce fluid to these parts, in order to pre- 
serve the contents, and prevent further formation of 
gases. The method for doing this will be given under 
cavity embalming. 

The Small Intestines. — The small intestine is a convo- 
luted tube, extending from the pyloric end of the stomach 
to the ileo-caecal valve where it terminates in the large in- 
testines. It fills up the greater part of the abdominal and 
the pelvic cavity. It is about twenty feet in length and 
gradually diminishes in size from the commencement to 
the termination. 

The small intestines are surrounded at the top and at 
the sides by the large intestines. The small intestines 
are held in place by the mesentery, a part of the peri- 
toneum, which connects or fastens to the spine. 

The small intestines are divisible into three portions: 
Duodenum, Jejunum, and the Ileum. 



ORGANOLOGY 107 

Arteries. — The main arterial supply to the small in- 
testines is through the superior mesenteric artery. 

The superior mesenteric vein withdraws the main part 
of the blood from the small intestines. 

Duodenum. — The duodenum has received its name 
from being about equal in length to the breadth of twelve 
fingers (ten inches). 

It is the shortest, widest and the most fixed part of 
the small intestines, being closely and firmly attached to 
the posterior abdominal wall. It is not covered by the 
mesentery. The upper half of the duodenum is in the 
epigastric region and the lower half is in the umbilical 
region. It is practically in the median line of the body. 

The duodenum is shaped like a horseshoe, the opening 
being directed toward the left. The arteries supplying 
the duodenum are the pyloric and the pancreatic duo- 
denal branch of the superior mesenteric. The veins cor- 
respond to the arteries. 

The pancreatic duct and the bile duct empty into the 
duodenum at its middle portion. 

Jejunum. — The jejunum is the second portion of the 
small intestines, it derives its name from the latin word 
"jejunas, " meaning empty, because it was formerly sup- 
posed to be empty after death. 

It is wider, thicker, more vascular and of a deeper 
color than the ileum. The jejunum is about eight feet in 
length or two-fifths of the length of the small intestines. 

The arteries which supply the jejunum are the 
branches of the superior mesenteric artery. The veins 
are of the same name. 



10$ ORGANOLOGY 

The jejunum is fastened to the posterior wall of the 
abdomen by an extensive fold of the mesentery. 

Ileum. — The ileum is derived from a Greek word mean- 
ing to twist, and is so named on account of its numerous 
coils and convolutions. It is the third portion of the 
small intestines and is placed below the jejunum. It is 
much narrower and thinner than the jejunum, about 
twelve feet in length or three-fifths of the length of the 
small intestines. It is also attached to the posterior ab- 
dominal wall by means of the mesentery. The arteries 
which supply the ileum are the branches of the superior 
mesenteric artery. The veins are of the same name. 

The villi are minute projections on the mucous mem- 
brane of the small intestines. They are largest and most 
numerous in the duodenum and jejunum, and become 
fewer and smaller in the ileum. It is in the villi of the 
intestines that we find the termination of the mesenteric 
arteries, the beginning of the mesenteric veins and the 
commencement of the lacteals. 

As the food passes down the intestines, having been 
previously prepared in the stomach and intestines for 
absorption, it comes in very close contact with the villi 
of the intestines and it is here that the nutrition from 
the food is absorbed through the villi wall into the lac- 
teals, and hence carried to the receptaculum chylii. 

The Large Intestines. — The large intestine extends 
from the termination of the ileum to the anus. It is about 
five or more feet in length or about one fifth of the whole 
extent of the intestinal canal. It is largest at its com- 
mencement at the caecum, and gradually diminishes in 



ORGANOLOGY 109 

size as far as the rectum, where there is a dilatation of 
considerable size just above the anus. 

The large intestine differs from the small intestine in 
its greater size, its more fixed position, its sacculated form. 

The large intestine in its course describes an arch, 
which surrounds the convolutions of the small intestines. 
It commences in the right inguinal region, in a dilated part 
of the caecum. It ascends through the right lumbar and 
the right hypochondriac regions to the under surface of 
the liver, it here takes a bend to the left, the hepatic flex- 
ure, and passes transversely across the abdomen on the 
confines of the epigastric and umbilical regions, to the 
left hypochondriac region ; it then bends again, the splen- 
ic flexure, and descends through the left lumbar region 
to the left inguinal region, where it becomes convoluted 
and forms the sigmoid flexure ; finally it enters the .pelvic 
cavity and descends along the posterior wall to the anus. 

The large intestine is supplied by the branches of the 
inferior mesenteric artery, and the veins are of the same 
name. 

The large intestines are divided into the caecum, colon 
and rectum. 

Caecum. — The caecum is the commencement of the 
large intestines, it is a large blind pouch situated below 
the ileo caecal valve. The ileo caecal valve is the valve 
between the exit of the small intestines and the com- 
mencement of the large intestines. The caecum is held 
mostly in place by the folds of the peritoneum. 

The Vermiform Appendix. — The appendix is found 
only in the human, the higher apes, and the wombat, 



110 



ORGANOLOGY 



although in certain rodents a somewhat similar arrange- 
ment exists. The appendix is a long, narrow, worm 




Fig. 24 — The caecum and colon laid open to show the ileo- 
caecal valve. (Gray) 

shaped, muscnlo-membranous tube, which starts from the 
inner side of the posterior wall of the caecum, below and 
behind the termination of the ileum. It is the seat for 
a very common disease called appendicitis. It varies 
from one half to nine inches in length, its average being 
about three inches. Its diameter is from one eighth to 
one quarter of an inch. 



ORGANOLOGY HI 

The Colon. — The colon is divided into three parts, the 
ascending, transverse and the descending colon. 

The ascending colon is smaller than the caecum, with 
which it is continuous. It passes upward from its com- 
mencement at a point corresponding to the ileo-caecal 
valve, to the under surface of the right lobe of the liver, 
on the right of the gall bladder, where it is lodged in a 
shallow depression on the liver; here it bends abruptly 
inward to the left, forming the hepatic flexure. It is 
held to the posterior wall of the abdomen by folds of the 
peritoneum. 

The transverse colon is the longest part of the small 
intestines, passes transversely from the right to the left 
across the abdomen, opposite the confines of the epigas- 
tric and umbilical regions, where it curves downward 
beneath the lower end of the spleen, forming the splenic 
flexure. In its course the transverse colon describes an 
arch, the concavity of which is directed backward toward 
the vertebral column and a little upward. 

This is the most movable part of the colon, only cov- 
ered by peritoneum and held to the back wall by the 
folds of the peritoneum. The transverse colon is in rela- 
tion, by its upper surface with the liver and gall bladder 
the great curvature of the stomach, and the lower end 
of the spleen; by its under surface with the small intes- 
tines; by its anterior surface with the anterior layers of 
the great omentum and the abdominal wall; its posterior 
surface on the right is in relation with the duodenum and 
on the left it is in contact with the convolutions of the 
jejunum and ileum. 



112 ORGANOLOGY 

The descending colon passes downward through the 
left hypochrondriac region and lumbar region along the 
outer border of the left kidney. At the lower end of the 
left kidney it turns inward where it terminates in the 
formation of the sigmoid flexure. The descending colon 
is held to the back wall by folds of the peritoneum. 

The sigmoid flexure, the narrowest part of the colon, 
is situated in the left inguinal region and communicates 
with the rectum. 

The Rectum. — The rectum is the terminal part of the 
large intestines, and extends from the termination of the 
sigmoid flexure to the anus. The adult rectum in male 
is from four to six inches in length, and in the female is 
from three to five inches in length. 

The anus is the terminal opening of the alimentary 
canal. 

Liver. — The liver is the largest gland in the body, 
and is situated in the upper and right part of the ab- 
dominal cavity, occupying almost the whole of the right 
hypochondriac, the greater part of the epigastric, and ex- 
tending almost to the middle of the left hypochondriac 
region. 

In the male it weighs from fifty to sixty ounces, and in 
the female, from forty to fifty. 

It is relatively much larger in the foetus, being about 
one-eighteenth of the body weight in the foetus, and in 
the adult, about one-thirty-sixth of the body weight. 

Its greatest width is from seven to eight inches, is 
about twelve inches long, and in its greatest thickness 
about three inches. 



ORGANOLOGY 



113 



The liver is very soft and is easily lacerated and fri- 
able ; its color is a dark reddish brown. To obtain a cor- 
rect idea of its shape, you might compare it to a wedge, 
the base of which is directed to the right, and thin edge 
toward the left. 

The liver has five surfaces, superior, inferior, anterior, 
posterior and right lateral. 

The liver has five lobes, right and left, caudate, quad- 
rate, and lobus spigelii. It has five ligaments, right and 
left lateral or triangular, falciform, coronary and round. 
The liver has five fissures, the umbilical, the fissure of the 
ductus venosus, the transverse fissure, the fissure for the 
gall bladder, the fissure for the vena cava. These fissures 
can be represented by the letter H. 






»« 2 

•2fl§ 



u 

is 



BACK 

Transverse 



FRONT 



O H>t5j 

5 h a 

< a 

3 3 
a i 



Eg''*! 

&■«, 'to' 

2* c 

** fij •"" 



o 
w 



The liver is movable within certain narrow limits. 
It moves with respiration. On inspiration, it moves down 
with the diaphragm to a little below the right nipple 
line. The ligaments do not give the liver much support 
because they lie relaxed, but it does get its main support 
from the connective tissue which unites the liver to the 
diaphragm, the hepatic veins which join the vena cava 
and also by the intra-abdominal pressure resulting from 
the tonic contraction of the abdominal muscles. 



114 



ORGANOLOGY 



Also when the abdominal tension is normal, the in- 
testines are driven up, and become a bed for the liver. 

The most important function is the secretion of the 
bile; it is also the excretor of deleterious matter and im- 
purities. It also effects important changes of the blood 
in its passage through it, for the portal circulation. 

The excretory appartus of the liver consists (a) of the 

hepatic duct, (b) the gall 
bladder, (c) cystic duct, (d) 
the common bile duct. 

The hepatic duct is formed 
by two main trunks nearly 
of equal size which issue 
from the liver, one from the 
right- and one from the left 
lobe. The hepatic duct pas- 
ses downward and to the* 
right from one to two inches 
where it is joined at an acute 
angle with the cystic duct. 

The Gall Bladder.— The 

bladder is a reservoir for 
the bile. It is a con- 
ical or pear-shaped 
sack, lying on the 
under surface of the 
right lobe of the 

Fig. 25— Excretory \1\ „.-,,«-. ,. Ti . , 

apparatus of the \U"" duodenum llver - Xt 1S ab ° Ut 

liver. (Poirier and V I f Qur inches in length, 
Charpy) 




pAKCseaTie 

DUCT 



ORGANOLOGY 115 

one inch in depth and holds from eight to ten drams. 

The cystic duct is about an inch and a half in length, 
and passes obliquely downward to the left from the neck 
of the gall bladder, and joins the hepatic duct. 

The common bile duct (ductus communis choledochous) 
is the common excretory duct of the liver and the gall 
bladder, and is formed by the union of the cystic and 
hepatic ducts. It descends to the middle portion of the 
duodenum, where it unites with the pancreatic duct, the 
two passing obliquely through the wall of the descending 
portion of the duodenum. The tissues of the liver are 
nourished by the blood from the hepatic arteries. 

The Pancreas. — The pancreas (the sweet bread) is 
a gland similar in structure to the salivary glands; is 
about seven inches long, of a grayish white color; its 
weight varies from two to six ounces. It is situated be- 
hind the stomach, and it secretes the pancreatic juice. It 
extends to the right in a part of the epigastric space. 
The tail lies above the left kidney, and is in contact with 
the lower engl of the spleen and in the left hypochon- 
driac region ; the body lies behind the stomach and trans- 
verse colon and in front of the great aorta, portal vein 
and inferior vena cava. The arteries nourishing it are 
the large and small pancreatic, which are branches of the 
splenic artery. 

The pancreatic duct is the principal excretory duct 
of the pancreas. -It extends transversely from the left 
to the right through the substance of the pancreas. 

After leaving the body of the pancreas, it unites with 
the common bile duct of the liver where it empties into the 



116 



ORGANOLOGY 



duodenum (first section of the small intestines after 
leaving the stomach). 

The pancreatic duct carries pancreatic juice (a diges- 
tive fluid) from the pancreas to the duodenum. 

The Spleen. — The spleen belongs to that class of bodies 
known as ductless glands and has no excretory duct; 
is oblong, flattened, soft, very brittle, very vascular, of 
a very dark bluish red color; is situated in the left hy- 
pochondraic region behind and to the left of the stomach ; 
is five inches long, three inches wide and two inches 
thick and weighs about seven ounces. The vessels which 
nourish it are the splenic artery and splenic vein. 
Function. It is supposed to furnish blood corpuscles. 

The Kidneys. — The kidneys are large glands, two in 




FlG. 26 — The abdominal aorta and its branches. (Gray) 



ORGANOLOGY 117 

number and are situated from five to six inches apart or 
about three inches on either side of the median line in the 
right and left lumbar regions. 

The upper extremity of the kidneys lies on the level 
of the twelfth dorsal vertebra and the lower extremity 
on the level of the third lumbar vertebra. Bach kidney 
is four and one-half inches in length, two to two and one- 
half inches in breadth, a little more than one inch in 
thickness. 

The weight of the kidney in the adult male is from four 
and one-half to six ounces each. In the adult female the 
weight would be from four to five and one-half ounces. 

Their function is to separate from the blood certain 
waste products and an excess of water, the combination 
of which we know as urine. The principal products 
excreted by the kidneys from the blood along with water 
are ammonia and urea. The blood is taken to the kidneys 
by the renal arteries and the renal veins carry it back 
to the blood circulation. 

The urine is then taken from the kidneys by the 
ureters and conveyed to the urinary bladder. 

The Ureters. — The ureters are cylindrical tubes about 
sixteen inches in length and of diameter of a goose-quill. 

The Suprarenal Capsules. — The suprarenal cap- 
sules belong to that class of bodies known as ductless 
glands and are two small flattened bodies of yellowish 
color, situated at the back of the abdomen, behind the 
peritoneum (the covering for all of the abdominal organs), 
and immediately above and in front of the upper end of 



118 ORGANOLOGY 

each kidney. The name is derived from the position it 
occupies in relation to the kidney, supra meaning above, 
and renal pertaining to the kidneys. 

The functions are as yet unknown. The suprarenal 
arteries furnish nourishment for the suprarenal cap- 
sules. 

The Pelvic Cavity. — The pelvic cavity is that portion of 
the abdomen situated between the ilium and pubic bones, 
or in other words the extreme lowest portion of the ab- 
dominal cavity. The organs located within this cavity 
are the bladder in the male and the bladder and the 
uterus (womb) in the female. 

The Bladder. — The urinary bladder is a reservoir for 
the urine, situated in the pelvic cavity behind the pubic 
bone. In life it is supplied with blood by the anterior 
branches of the internal iliac arteries accompanied by the 
internal iliac veins. 

The Uterus. — The uterus is the organ of gestation, re- 
ceiving the fecundated ovum into its cavity, retaining it, 
and supporting it during the development of the foetus, 
and becoming the principal agent in its expulsion at the 
time of parturition (delivery). It is nourished in life by 
branches of the internal iliac artery, which is accompanied 
by the iliac vein. 

The uterus is situated in the pelvic cavity between 
the rectum and the bladder, and is held in position by the 
lateral and round ligaments on each side. The uterus 
is about 3 inches in length, 2 inches in breadth and weighs 



ORGANOLOGY 119 

from one to two ounces. It is composed of three coats, 
external serous, middle muscular, and internal mucous. 
The serous coat, derived from the peritoneum, is thin 
and vascular. 

The muscular coat is the chief coat, it is dense, firm, of 
a grayish color and cuts like cartilage. 

The mucous coat is thin, smooth and closely adherent 
to the muscular coat. It is highly vascular. 

The blood supply to the uterus is the uterine arter- 
ies which are the posterior branches of the internal iliac 
arteries, and the ovarian arteries which are branches of 
the aorta. These break up in capillaries and form a fine 
network plexus in the coats of the uterus. 

The veins are of large size and are the uterine which 
empty into the internal iliac veins and the ovarian veins. 
On the right side the ovarian vein empties into the as- 
cending vena cava, and on the left side into the renal vein. 

Prostate. — The prostate gland is a pale, firm glandular 
body, which surrounds the neck of the bladder in the 
male. Its shape and size resembles a horse chestnut. It 
weighs from one-half to one ounce and measures one 
and one-half inches across and three quarters of an inch 
deep. Its structure is inclosed by a firm thin fibrous cap- 
sule. Its substance is of a pale reddish grey color and 
is composed of glandular substance and muscular tissue. 

The arteries that supply the prostate are derived 
from the internal pubic, a branch of the internal iliac. 

The veins form a plexus around the gland and com- 



120 



ORGANOLOGY 



municate with veins which empty into the internal iliac 
veins. Its function is to secrete an opaque fluid. 

The Peritoneum. — During life and in the uncut corpse 
the peritoneal cavity is air-tight. It is not a real cavity, 
as muscular tension and atmospheric pressure permit no 
vacant space to form. Wjien the surgeon or embalmer 




Fig. 27— The Peritoneum. (Gray) 



ORGANOLOGY 121 

opens the abdomen, the peritoneal cavity is at that mo- 
ment produced. 

The peritoneum is the largest serous membrane in the 
body. In the male it is a closed sac, a part of which is 
applied against the abdominal sides, while the remainder 
is reflected over the contained viscera. In the female 
it is not a closed sac, since the free extremities of the 
fallopian tubes open directly into the peritoneal cavity. 

The parietal peritoneum is that portion applied 
against the abdominal sides. 

The visceral peritoneum is that portion reflected over 
the viscera. 

The peritoneum consists of two sacs. 

The greater sac lines the greater part of the ab- 
dominal cavity as almost all of the viscera are covered 
by it. 

The lesser sac is placed behind the stomach. These 
two sacs communicate with each other by a narrow ori- 
fice called the Foramen of Winslow. 

The peritoneum, as it covers different organs or sets 
of organs, receives special names. 

The lesser omentum consists of two layers, these 
split to envelope the stomach. 

The greater omentum consists of four layers. Two 
of these layers extend from the stomach and together 
with two other layers of the same structure which en- 
velope the transverse colon, form an apron for the in- 
testines. 



122 ORGANOLOGY 

The mesentery consists of two layers which invests 
the small intestines. Between the two layers of the mes- 
entery we find the blood vessels, nerves, lacteals, and 
glands, leading to and from the intestines. The mesen- 
tery is fan shaped, and is attached to the second lumbar 
vertebra. The length of the mesentery fan is about 
eight inches from commencement to termination at in- 
testine. It extends the whole length of the intestines, 
which is about twenty feet. 






CHAPTER IX. 

THE VASCULAR SYSTEM. 

The Vascular System. — The vascular system is com- 
posed of the organs immediately concerned in the circu- 
lation throughout the body of the fluids which convey 
to the tissues the nutritive substances and oxygen nec- 
essary for their metabolism and carry from them to the 
excretory organs the waste products formed during meta- 
bolism. 

The system is usually regarded as being composed of 
two portions, the one consists of organs in which circu- 
late the red fluid which we term blood, and called the 
blood vascular system, while the organs of the other con- 
tain a colorless or white fluid known as lymph or chyle, 
and is known as the lymphatic circulation. 

) arteries 
capillaries 

VdnS 
^ ( The lymphatic circulation 

The Blood Vascular System. — A knowledge of the 
general features of the circulatory system are essential 
to the undertaker and the embalmer as a means of enab- 
ling him not only to perform the ordinary operations and 

123 



124 THE VASCULAR SYSTEM 

duties of his profession intelligently, but to equip him 
with the knowledge necessary to meet the exceptional 
conditions which sometimes arise. 

There is a growing appreciation of the fact, also, that 
thoroughness in the practice of embalming is worth striv- 
ing after. Many cases of embalming, no doubt, require 
a minimum amount of attention, particularly where the 
body is to be kept but a short time. Where preservation 
for longer periods is required, as for transportation, or 
where disease and accident have interfered seriously with 
the circulation, a more exact knowledge is evidently de- 
sirable. 

The blood vascular system comprises the heart, which 
is the central organ of the whole system, and all the blood 
vessels. This system, with its arteries and veins, perme- 
ates the whole body and becomes divided and subdivided 
at its outer portion into vessels constantly decreasing in 
size, until those extremely minute vessels, the capillaries, 
are reached. All the tissues of the body are very rich in 
these, so that all portions of the body are supplied with 
blood, which is essential for the nourishment and re- 
building of the tissues. The large vessels which convey 
blood from the heart are termed arteries, while the ves- 
sels which convey the blood back to the heart are termed 
veins. 

For one to properly embalm the human body, it is 
necessary to understand the way the fluid will circulate 
through the body, and the only way we can do this is 
to study the circulation of the blood as it would occur in 
life. 



THE VASCULAR SYSTEM 125 

To facilitate the description of the blood vascular sys- 
tem. It has been divided into six subdivisions as follows : 

(1) Systemic. 

(2) Pulmonary. 

(3) Coronary. 

(4) Portal. 

(5) Foetal. 

(6) Collateral. 

The Systemic Circulation. — The systemic circulation 
is called the greater circulation of the body. The course 
of the blood is from the left ventricle of the heart through 
the aortic semi-lunar valve to the great aorta and its 
branches which end in capillaries in the tissues of the 
body then through the veins the terminal trunks of which 
end in the right auricle of the heart. So the systemic 
circulation is the circulation of the blood from the left 
ventricle of the heart to the right auricle of the heart and 
this circulation has the important function of carrying 
oxygen to the tissues to nourish them, and of carrying 
carbonic acid gas back to the heart which is a waste pro- 
duct of the tissues. 

The systemic circulation is divided for the sake of 
convenience into the following: 

(1) The arterial system. 

(2) Capillary. 

(3) The venous system. 

The Arterial System. — The blood leaving the heart 
passes from the left ventricle through the aortic semi- 
lunar valve, into the ascending aorta. Here the two 



126 



THE VASCULAR SYSTEM 



coronary arteries come off which go to supply the mus- 
cular tissues of the heart. The ascending aorta passes 
into the arch of the aorta. Here are given off the in- 
nominate artery to the right and the common carotid 

and the subclavian to the left. 
The innominate is only about 
an inch or two in length, and 
divides into the right common 
carotid and the right subclavian 
arteries. On each side the sub- 
clavian passes down beneath 
the clavieal bone and enters the 
axillary space where it is known 
as the axillary artery. After 
leaving the axillary space, the 
artery passes down the arm and 
is known as the brachial artery. 
About one inch below the bend 
of the elbow the artery divides 
into two branches, known as the 
radial and ulnar. The radial 
goes to the thumb side of the 
hand, and the ulnar to the little finger side of the hand. 
The ulnar artery and a branch of the radial form the pal- 
mar arch, which gives off the branches to the fingers. Com- 
ing off the brachial are the deep brachial arteries and the 
anastomotica magna arteries which anastomose and give 
collateral circulation to the forearm, by means of the re- 
current radial and ulnar arteries. 

The common carotid arteries pass up each side of the 
neck to a point opposite the Adam's apple, where they, 




Fig. 28 -The arch of the 

aorta and its branches. 

(Gray) 



THE VASCULAR SYSTEM 



127 



divide into the external carotid, which supplies the mus- 
cular tissue of the face, and the internal carotid artery, 
which goes up through the skull and helps to form the 
circle of Willis. 

The vertebral arteries come off the subclavian arteries 
on either side and pass upward, winding through the 




Fig. 29 — The internal carotid and vertebral arteries. (Gray) 

foramen of the vertebrae, until finally arriving inside 
the cranial cavity, unite to form one artery called the 
basilar, which helps to form the circle of Willis. 

The circle of Willis is situated at the base of the brain 
and gives off to the front the two anterior cerebral ar- 



128 



THE VASCULAR SYSTEM 




Fig. 30 -The circle of Willis. 
(Spalteholz) 



teries, to the sides the two middle cerebral arteries, and 

to the back the two 
posterior cerebral ar- 
teries. The two an- 
terior cerebral arteries 
are connected by the 
anterior communicating 
branch, and the middle 
cerebral artery and the 
posterior cerebral ar- 
teries on each side are 
connected by the pos- 
terior communicating 
branches. The cerebral 
arteries terminate in 
the piamater as a dense 

capillary network, and from there supply the substance 

of the brain with nutrition. 

The external carotid artery supplies the muscular 
tissues of the face. The external carotid artery arises 
from the common carotid artery at about the level of the 
upper border of the thyroid cartilage — a level which cor- 
responds with the body of the fourth cervicle vertebra. 
Thence it is directed upward and slightly backward to- 
wards the angle of the jaw, where it enters the substance 
of the parotid gland and continues upward in that struc- 
ture to just below the root of the zygoma. Here it gives 
rise to a large branch, the internal maxillary, and is then 
continued upward over the root of the zygoma upon the 
side of the skull, this terminal portion of it being termed 



THE VASCULAR SYSTEM 



129 



the superficial temporal artery. The branches of the ex- 
ternal carotid artery from below upward are (1) the 
ascending pharyngeal, (2) the superior thyroid, (3) the 




Fig. 31 — The arteries of the face 
and scalp. (Gray) 



Fig. 32 — The external carotid and 
its branches . ( Gray ) 



lingual, (4) the occipital, (5) the facial or external maxil- 
lary, (6) the posterior auricular, (7) the internal maxil- 
lary, (8) the superficial temporal. 

The arch of the aorta now continues into the thoracic 
aorta, so called while it is in the thoracic cavity, and 
after it has passed through the diaphragm becomes the 
abdominal aorta. At a point opposite the umbilicus or 
navel the abdominal aorta divides into the two common 
iliac arteries. Each common iliac artery divides into 
an internal iliac artery, which supplies the organs of the 
pelvic cavity, and an external iliac artery, which passes 



130 



THE VASCULAR SYSTEM 



ft 



*: Wi 



H 



Fig. 33- The anterior tibial Fig. 34 — The popliteal, posterior 
artery. ( Gray) tibial , and peroneal arteries. ( Gray) 



THE VASCULAR SYSTEM 131 

beneath Poupart's ligament. As the artery passes down 
the leg it is known as the femoral artery, until it passes 
into the popliteal space, where it is called the popliteal 
artery. About one inch below the popliteal space the 
artery divides into the anterior tibial artery, which runs 
on a straight line down the front and outside of the leg 
to a point between the big toe and the one next to it, 
and the posterior tibial artery which passes down the 
back part of the foreleg between the inside ankle and 
the heel. The peroneal, a branch of the posterior tibial, 
passes down the foreleg between the outside ankle and 
the heel. The anterior tibial artery, as it passes through 
the instep is known as the large dorsal artery and fur- 
ther on is known as the small dorsal artery. In the foot 
is the plantar arch, formed by branches of the posterior 
and anterior tibial arteries, which send out branches to 
each toe. 

Coming off the femoral are the deep femoral and the 
anastomotica magna arteries, which anastomose and form 
collateral circulation to the foreleg by means of the re- 
current anterior and posterior tibial arteries. 

Coming off the subclavian arteries are the superior 
and inferior mammary arteries, which pass down over 
the chest wall, anastomose and give collateral circulation 
to the lower extremities by means of the superior and in- 
ferior epigastric arteries, branches of the external iliac 
and femoral arteries. 

The thoracic aorta gives off the intercostal arteries, 
which supply the ribs, the bronchials which supply the 



132 THE VASCULAR SYSTEM 

lungs, the esophageal which supplies the esophagus, and 
the pericardiac which supplies the pericardium. 

The abdominal aorta gives off in rotation the coeliac 
axis, which as a hub in a wheel gives off three spokes, 
the gastric artery to the stomach, the hepatic to the liver, 
and the splenic artery to the spleen. The next branch 
is the phrenic, which supplies the diaphragm, then the 
suprarenal artery, two or more in number coming off 
of both the aorta and the renal arteries. The suprarenal 
arteries supply the suprarenal capsules. The next 
branch is the superior mesenteric artery, which supplies 
the small intestines ; the next branch is the renal arteries, 
which supply the kidneys ; the next branch is the sper- 
matic or the ovarian arteries, which supply the testes in 
the male or the ovaries in the female ; the inferior mesen- 
teric artery, which supplies the large intestines. Also 
coming off the aorta at regular intervals are the lumbar 
arteries, which supply the side walls. 

The Capillary Circulation. — The capillaries are very 
minute blood vessels, forming a network between the 
terminating arteries and the commencing veins. 

They derive their name from the word capillus (hair). 
They vary in size from 1-3500 to 1-3000 of an inch, the 
largest capillaries being those of the skin. These little 
vessels are so thickly distributed throughout most of the 
tissues of the body as to make it impossible to insert a 
cambric needle in the flesh without pricking scores of 
them. 



THE VASCULAR SYSTEM 



133 



When we embalm a body the object should be to intro- 
duce a sufficient amount of fluid through the arterial 
system so that these tiny capillaries will be filled. These 
little vessels are so minute and the walls are so thin that 
the fluid is immediately taken up into the tissues. If 
every tissue of the body can be supplied with fluid by 
means of the capillaries, we would have the ideal, the 
body would be perfectly embalmed. Let 
us then not only be arterial embalmers, 
but, better still, let us be capillary and 
tissue embalmers. 

Capillaries have one wall, which is 
the continuation of the inner wall of the 
artery, thus making the capillary so thin 
that fluid finds its way easily through it 
into the surrounding tissues. 

Some parts of the body are more vas- 
cular than others and some tissues of the 
body, such as the cornea of the eye, the 
epidermis, cartilage, the substance of the 
brain, etc., are entirely destitute of capil- 
laries. 

The combined area of all the capil- 
laries of the body is many times greater 
than the combined area of the trunk 
vessels. If this were not so, the high pressure on the 
arterial system would break the thin capillary walls and 
also the greater area allows the blood to circulate more 
slowly which gives time for the liberation of oxygen to 




Fig. 35— Capillaries 

a, cells; b, nuclei. 

(Gray) 



134 THE TASCULAR SYSTEM 

the tissues and for the absorption of carbon dioxide. 

The Venous System. — The veins, like the arteries, are 
tubular vessels, their function being to receive the blood 
from the capillaries and convey it to the auricles of the 
heart. There are two classes of veins, systemic and 
pulmonic. 

The systemic veins receive the impure or carbonized 
blood from the capillaries and convey it to the right 
auricle of the heart. 

The pulmonic veins receive the pure oxygenized blood 
from the lungs and convey it to the left auricle of the 
heart. The pulmonic veins will be taken up and discussed 
later under the pulmonary circulation. 

Systemic veins are divided into superficial and deep 
veins and sinuses. 

The superficial veins are found between the layers of 
the superficial fascia, just beneath the skin, and com- 
municate with the deep veins by branches which pierce 
the fascia. 

The deep veins are found deeper down, between the 
muscles, and are surrounded by the deep fascia. 

The smaller arteries, such as the radial, brachial, pos- 
terior and anterior tibial, and the peroneal arteries, are 
each accompanied by two veins, one on each side of the 
artery, which are called venae comites (accompanying 



THE VASCULAR SYSTEM 



135 



veins). The larger arteries, such as the common carotid, 
the femoral and the iliac, are accompanied by only one 
vein. 

Veins arise from the capillaries, or, rather, from the 
minute capillary plexus, formed by a massing or blend- 




FiG. 36 — Superficial veins of the head and neck. (Gray) 



ing of the tiny venules. These small vessels unite to form 
larger trunks, and as they continue toward the heart in- 
crease in size until they finally unite to form the ascend- 
ing and descending venae cavae. 



136 



THE VASCULAR SYSTEM 



The Sinuses. — The cerebral veins are small vessels that 
arise from the capillaries of the brain, and terminate in 
the sinuses of the duramater. There are many sinuses 
in the cranial cavity, and differ from the vein, in that 
the walls are thinner, having only two walls while the 
veins have three, and they do not have valves. The outer 
walls of the sinuses of the brain are formed by a division 
of the dura mater, while the inner wall is the continuation 
of the inner wall of the vein. 

They are of little interest to embalmers, 
except for the fact that when the brain is 
injected by any of the so-called needle 
processes, the fluid is quickly conveyed 
through these vessels to the tissues of the 
brain, and that organ is thoroughly 
preserved. 

The vessels starting at the foot are the 
anterior and posterior tibial veins, which 
unite just below the knee to form the 
popliteal vein, in the popliteal space. 
Another vein starts from the foot and runs 
into the popliteal vein called the external 
short saphenous. Starting also at the foot 
and running into the posterior tibial vein 
is the peroneal vein. 

The popliteal vein after leaving the 
popliteal space is known as the femoral 
vein as it passes up the leg, to Poupart's 
ligament. Another vein, the internal long 
saphenous, starts at the foot, and runs into 



Fig. 37— The inter- 
nal long saphenous 
vein. (Gray) 



THE VASCULAR SYSTEM 



137 



the femoral vein about an inch below Poupart's ligament. 

After passing beneath Poupart's 
ligament the vessel is called the 
external iliac. Coming from the 
organs of the pelvic cavity is the 
internal iliac, which joins with the 
external iliac vein to form the com- 
mon iliac vein. The right and left 
iliac veins join opposite the um- 
bilicus to form the ascending vena 
cava. The ascending vena cava 
passes upward to the right of the 
vertebral column through the dia- 
phragm and enters the right auricle 
of the heart by means of the eustach- 
ian valve. 

In the forearm are the radial 

veins on the thumb side of the hand, 

the ulnar veins on the little finger 

side of the hand, and the median 

vein just between the radial and 

ulnar veins. The median vein 

divides into the median cephalic vein 

and the median basilic. The median 

cephalic vein unites with the radial 

vein to form the cephalic vein, which 

runs up the back part of the arm 

, and finally empties into the sub- 
FiG. 38— The superficial . . , 

veinsofthearm. (Gray) clavian vein. The median basilic 




138 



THE VASCULAR SYSTEM 



unites with the ulnar vein to form the basilic, which runs 
up the inner part of the arm between the biceps and tri- 
ceps muscles. The deep brachial veins or the vena comites, 
two in number, which follow the brachial artery, run into 
the basilic vein. When the basilic vein arrives at the axil- 
lary space it takes on the name of the axillary vein, and as 
the vessel passes beneath the subclavian bone, it becomes 
the subclavian vein. The right and left subclavian veins 
with the right and left internal jugular veins from each 
side of the head form the right and left innominate veins, 
which unite to form the descending vena cava, which 
runs into the right auricle of the heart. 

Starting at the head, the superior longitudinal sinus 
begins at the fore part of the brain and runs backward 




Fig. 39 - Vertical section of the 
skull, showing the sinuses of the 
dura mater . ( Gray ) 



THE VASCULAR SYSTEM 



139 



between the two hemispheres of the brain and empties into 
the wine press or Torcular herophili. The inferior 
longitudinal sinus begins at the fore part of the brain, 
but runs deeper down in the pia mater between the two 
hemispheres of the brain, terminates in the straight 
sinus which empties into the wine press. Beginning at 
the base of the cerebellum are the two occipital sinuses 
which run together and terminate in the wine press. 
After all the blood has been gathered together in the 




^Torcirtar Herophili. 
Fig. 40— The sinuses at the base of the skull. (Gray) 



140 THE VASCULAR SYSTEM 

wine press, it leaves by means of the right and left lateral 
sinuses which pass down as far as the jugular foramen. 
Beginning at the base of the brain in front are the right 
and left cavernosus sinuses, which run into the inferior 
petrosal sinuses, which pass down as far as the jugular 
foramen, where they join the lateral sinuses to form the 
right and left internal jugular vein. The superior pe- 
trosal sinus is between the lateral sinus and the caverno- 
sus sinus uniting them. Joining the right and left 
cavernosus sinuses is the circular sinus and joining 
the right and left inferior petrosal sinuses is the trans- 
verse sinus. The right and left internal jugular veins 
pass down through the jugular foramens and down the 
neck to where they with the right and left subclavian 
veins form the right and left innominate veins. The right 
and left innominate veins unite to form the descending 
vena cava which empties into the right auricle of the 
heart. 

Beginning in the tissues of the heart are the coronary 
veins, which terminate in the coronary sinus and then 
into the right auricle of the heart through the coronary 
valves. 

The azygos system consists of the major azygos vein, 
which starts at the right external iliac vein and empties 
into the descending vena • cava; the minor azygos vein 
which starts at the left external iliac vein and empties 
into the major azygos vein back of the heart; and the 
tertiary azygos vein, which starts at the left subclavian 
vein and empties into the minor azygos vein. The azy- 
gos veins collect all the blood from the side walls of the 



THE VASCULAR SYSTEM 



141 



body and form a perfect collateral circulation between 
the superior and inferior caval systems, and thoroughly 

equalizes the blood pressure all 
over the body. The major azygos 
vein receives the following: the 
right intercostal veins, excepting 
the first ; the azygos minor ; the 
right bronchial vein; the esopha- 
geal vein ; the pericardiac ; and the 
posterior mediastinal veins. The 
minor azygos vein receives the fol- 
lowing : the tertiary azygos vein ; 
the lower five left intercostal 
veins; the small left mediastinal 
veins; the lower left esophageal 
veins. The tertiary azygos re- 
ceives the following: the fifth, 
sixth and sometimes the seventh 
intercostal veins ; the lower end of 
the lower left superior intercostal 
vein; and the left bronchial vein. 
The inferior vena cava receives 
the, following veins : the lumbar 
veins ; the hepatic veins ; the 
phrenic veins ; the renal veins ; the right suprarenal 
vein; the right spermatic or ovarian vein. The left 
spermatic or ovarian vein and the left suprarenal vein 
empty into the left renal vein. 

The Pulmonary Circulation. — This is the circulation 
existing between the right ventricle of the heart through 
the lungs back to the left auricle of the heart. 




FiG. 41 — The azygos sys- 
tem and venae cavae with 
branches. (Gray) 



142 THE VASCULAR SYSTEM 

The pulmonary artery takes its origin from the sum- 
mit of the right ventricle. It is about two inches in 
length, and is directed upward, backward and slightly 
towards the left, and beneath the arch of the aorta it 
divides into the right and left pulmonary arteries. These 
end in a system of capillaries in between the air cells of 
the lungs, where carbon dioxide is thrown off and oxygen 
taken on. 

The pulmonary veins are four in number, two passing 
from the root of each lung to the posterior surface of the 
left auricle of the heart. Each vein is formed at the root 
of the lung by the union of a number of smaller vessels 
which take origin ultimately from the capillary net work 
formed from the branches of the pulmonary artery, and 
to a certain extent from that formed by the bronchial 
arteries. Each pulmonary vein is about six inches in 
length. 

The Coronary Circulation. — The heart receives its 
blood supply through the two coronary arteries which 
arise from the aorta immediately above its origin, the 
return flow being by the coronary veins which open into 
the right auricle of the heart by the coronary sinus. The 
branches of the coronary arteries upon the surface of the 
heart are, as a rule, all end arteries ; that is, arteries which 
form no direct anastomosis with their neighbors. Prac- 
tically no blood can be carried directly, therefore, by the 
left coronary artery into the territory supplied by the" 
right one, or vice versa. 

The coronary sinus is a short venous trunk a little 
over an inch in length, which occupies the right half of 



THE VASCULAR SYSTEM 



143 




Fig. 42 — A front view 
of the heart showing 
coronary arteries. 
(Spalteholz) 



Fig. 43— A back view 
of the heart showing the 
coronary sinus, and ves- 
sels entering and leaving. 
(Spalteholz) 



144 THE VASCULAR SYSTEM 

that portion of the auriclo-ventricular groove whfch lies 
between the left auricle and ventricle. At the right end 
it opens into the right auricle, its orifice being guarded 
by the Thebesian valve. 

The Portal Circulation. — This circulation is of little or 
no value to the embalmer, as no part of it is directly re- 
quired to supply any of the tissues with embalming fluid. 

The portal circulation is formed by the superior mes- 
enteric vein and the splenic vein uniting to form 
the portal vein. The inferior mesenteric vein runs into 
the splenic vein; the gastric and cystic veins run into the 
portal veins. The portal vein ends in capillaries in the 
liver, where certain important changes take place, namely, 
the taking out of the bile. 

The portal vein and its tributaries are unlike the 
veins in the general circulation, as there are no valves. 
Their function in life is to gather up food or nutrition 
for the blood, and to the embalmer is of no special im- 
portance, only to know how this circulation is made up. 
The vessels that convey blood to the liver in life and the 
fluid in death are discussed under the liver. 

After death, about one-fourth of the blood of the body 
is to be found in the portal system. This blood can in 
no way be removed, and this is one of the reasons why 
the embalmer is not able to draw more blood than he 
does. 

The Foetal Circulation. — The foetal circulation is that 
circulation existing between mother and unborn child. 

The placenta constitutes, from the third month of 
intra uterine life, the nutritive and respiratory organ of 



THE VASCULAR SYSTEM 



i45 



the foetus. The placenta consists of a maternal portion 
and a foetal portion. The maternal portion is that por- 
tion of the placenta next to the uterine wall of the mother. 
In this are intervillus blood spaces, which may be re- 
garded as derivations from the eroded maternal blood 
vessels. In the non-pregnant state the uterus is supplied 

with branches from the inter- 
nal iliac artery, which end 
in capillaries in the wall of the 
uterus. In the pregnant state 
the numerous branches of the 
arteries supplying the uterus 
do not end as capillaries, but 
pierce the basal plate of the 
placenta, where the arterial ves- 
sels lose their muscular coat and 
open directly into the intervill- 
us or intraplacental blood 
spaces. Maternal capillaries 
are wanting within the placenta, 
since they become early re- 
placed by the intervillus 
spaces. The maternal blood is 
carried away from these spaces 
by wide venous chanels, form- 
ing networks from which pro- 
ceed the larger venous trunks. 
The foetal portion of the placenta is that portion next 
to the child. Here end the terminal loops of the foetal 
blood vessels, the blood being conveyed to and from the 
placenta along the umbilical cord, by the umbilical 




Fig. 44— Plan of the foetal 
circulation. (Gray) 



146 THE VASCULAR SYSTEM 

arteries and vein. Although coming into close relation, 
the blood streams of the mother and of the child never 
actually mingle, because of the delicate septum which 
intervenes. The delicate septum, however, allows the 
free interchange of gases necessary for the respiratory 
function as well as the passage of nutritive substances 
into the foetal circulation. 

The umbilical cord connects the body of the foetus 
with the placenta, and conveys the foetal blood to and 
from the placenta to the child. This blood is carried by 
means of two umbilical arteries and one umbilical vein. 

The umbilical vein originates by means of capillaries 
in the placenta, traverses the cord and enters the body 
of the child at the umbilicus. The umbilical vein now 
enters the substance of the liver and passes from that 
organ to the ascending vena cava by means of the ductus 
venosus. The blood now enters the right auricle of the 
heart and the eustachian valve is so placed that this 
blood is thrown directly into the left auricle of the heart, 
from there into the left ventricle, and out into the aorta 
to find itself in the general circulation of the child. The 
blood coming from the upper extremities of the child 
finds its way into the right auricle of the heart by means 
of the descending vena cava, thence into the right ventri- 
cle, and out into the pulmonary artery. This artery 
after birth will lead the blood to the lungs, but before 
birth, in as much as the lungs are not functioning, the 
lungs can not accommodate this amount of blood, so it 
passes directly into the arch of the aorta by means of 
the ductus arteriosus, and thence into the general cir- 



THE VASCULAR SYSTEM 147 

culation. The umbilical or hypogastric arteries leave the 
internal iliacs, pass one on each side of the bladder to 
the umbilicus, and thence down the cord to the placenta, 
end there in capillaries, where the blood is now purified, 
and nourished for its return flow. 

The Collateral Circulation. — By collateral circulation 
is meant the anastomoses of arteries, or veins through a 
side branch. There are three great arterial collateral 
circulations in the body. One is in the arm, the deep 
brachial artery, and the anastomotica magna, coming off 




Fig. 45— Collateral anastomosis of veins 
(Poirier and Charpy) 

of the brachial artery and anastomosing with the recur- 
rent radial and ulnar artery. One is in the leg, the deep 
femoral artery, and the anastomotica magna coming off 
of the femoral artery and anastomosing with the recur- 
rent anterior and posterior tibial arteries. One over the 
front part of the body, the superior and inferior mam- 
mary arteries branches of the subclavian artery and anas- 
tomosing with the superior and inferior epigastric 
arteries, branches of the external iliac and femoral ar- 
teries. 

The Lymphatic Circulation. — The lymphatic system is 
a system of vessels which occurs abundantly in almost all 
portions of the body and converge and anastomose to 
form two or more main trunks, which open into the sub- 



148 THE VASCULAR SYSTEM 

clavian veins just before they are joined by the internal 
jugular. The vessels contain a fluid termed lymph, usu- 
ally colorless and containing numerous white blood cor- 
puscles known as lymphocytes. 

In those vessels which have their origin in the wall of 
the small intestines, the contained fluid has, especially 
during digestion, a more or less milky appearance, owing 
to the lymphocytes being loaded with particles of fat 
which they have taken up from the intestinal contents. 
On this account, these vessels are usually spoken of as 
lacteals, although it must be recognized that they are 
merely portions of the general lymphatic system. 

In certain respects the vessels of the system strongly 
resemble the veins. They arise from a capillary network, 
their walls have a structure closely resembling that of the 
veins, they are abundantly supplied with valves, and it 
may be said that the fluid which they contain flows from 
the tissues towards the subclavian veins. With these 
similarities there are combined marked differences. One 
of the most important of these consists in the fact that 
the capillaries of the lymphatics are closed and do not 
communicate with any other set of vessels as the venous 
capillaries do with the arterial; and another important 
difference is to be found in the frequent occurrence upon 
the lymphatic vessels of characteristic enlargements, the 
so-called lymphatic nodes or glands, quite different from 
anything occurring in connection with the veins. 

Throughout the body spaces of varying size are found, 
containing a clear, more or less watery fluid, which are 
called lymph spaces. These spaces do not communicate 



THE VASCULAR SYSTEM 149 

with the capillaries of the lymphatics, but are in such 
close relationship with them that the fluid easily finds its 
way into the lymph capillaries by osmosis, absorption, 
lymphocytes going out into these spaces and returning 
filled with the lymph fluid. 

The lymphatic capillaries, which are arranged in the 
form of networks of very different degrees of fineness and 
complexity, closely resemble in structure the blood capil- 
laries, their walls consisting of a single layer of endo- 
thelial cells. They differ from those of the blood vascular 
system not only in their ultimate branches being closed, 
but also in their general appearance. They are of greater 
caliber. 

The lymph vessels, which issue from the capillary net- 
works and convey the lymph ultimately to the subclavian 
veins, have the arrangement closely resembling that of 
the veins; the larger ones are usually situated alongside 
and accompany the course of the blood vessels. Just as 
the veins unite to form larger trunks as they pass from 
the capillaries toward their termination, so, too, the lym- 
phatics, but the- lymphatics present two peculiarities 
which distinguish them from the veins. They do not 
anastomose as abundantly as veins and there is not the 
same proportional increase in the size of the lymphatic 
vessel. The left trunk or thoracic duct is much larger 
than the right, beginning in the abdominal region and 
traversing the entire length of the thorax to reach its 
destination. It receives all the lymph returned from the 
lower limbs, the pelvic walls and viscera, the abdominal 
walls and viscera, the lower part of the right half and 



150 THE VASCULAR SYSTEM 

the whole of the left half of the thoracic viscera, the left 
side of the neck and head, and the left arm. The other 
trunk, the right lymphatic duct, is very short and some- 
times wanting. It receives the lymph from the upper 
part of the right side of the thoracic wall, from the right 
half of the thoracic viscera and the upper surface of the 
liver, the right side of the neck and head, and from the 
right arm. The structure of the larger lymphatic vessels 
is similar to the veins, but, as a rule, their walls are 
thinner than those of the veins of corresponding caliber 
and their valves are more numerous. The walls of the 
most robust trunks, particularly those of the thoracic 
duct, consist of three coats. From within outward these 
are: (a) the intima, composed of the endothelial lining 
and the fibro-subendothelial layer; (b) the media, made 
up of involuntary muscle interspersed with fibro-elastic 
tissue; and (c) the adventitia, consisting of fibro-elastic 
tissue and longitudinal bundles of involuntary muscle. 

Lymphatic nodes are scattered along the course of 
the lymphatic vessels, found in various regions of the 
body as elliptical flattened nodules of varying size. The 
embalmer will meet with these in the axillary and in- 
guinal regions, or when he is raising the axillary or 
femoral arteries. 



PART III. 



EMBALMING 

151 



Embalming 



The central thought of the modern funeral director 
in the care of the dead and in all the arrangements of 
the funeral is to remove so far as may be all that is nec- 
essarily painful to those who must place out of sight the 
body through which the soul of the dear one has ex- 
pressed itself, in all the ways that are prompted by 
affection. This does not seem to have been the case in 
the former days when the methods were in striking con- 
trast to those of today and were such as would intensify 
the suffering of the living. Beginning with the arrange- 
ment of the body in the room made cold by nature in 
winter or by the ice box in the summer and ending by 
lowering the body into an unlined grave, each detail 
seems to have been made with little thought of lessen- 
ing the pain caused by those things which necessarily 
have to be done. Perhaps the central thought in 
the old days was the same as that which was the com- 
fort offered upon funeral occasions by a former local 
pastor which was 'death is a horrible thing." If this 
was not the controlling thought, it is certain that many 
details of former funeral customs would be considered 

153 



154 EMBALMING 

horrible today. Today the aim is to lighten the burden 
and to cheer the hearts of those who mourn. 

The introduction of embalming in the seventies has 
been of untold benefit in improving the environment 
of the dead prior to interment. Recollections of the use 
of the old ice box, the crude and cumbersome cooler, 
the ice water to be cared for and the thought of the 
chilled body are not pleasant now, and were far from 
pleasant then to those into whose homes death had en- 
tered in hot weather. In winter natural cold was de- 
pended upon, the body being placed in the coldest place 
possible. With the best of care the results were uncer- 
tain and far from satisfactory. Modern embalming has 
changed all this. Its results are with rare exceptions 
certain and satisfactory and the embalmed body may be 
dressed and placed in a warm and comfortable room. 



CHAPTER X. 

MODES, SIGNS AND TESTS OF DEATH. 

Just as surely as we are born, just so surely must 
we die, and just as it is the physician's duty to care for 
the living body, if possible to keep it in a strong and 
healthful condition, so it is the embalmer's duty to care 
for the body after death, not so much for the body itself, 
but from a sanitary standpoint, namely, to see that the 
body is well disinfected and embalmed so that there 
will be absolutely no chance for the spread of disease. 

Any one who is familiar with hospital work must know 
that all do not die in the same way. For some it is the 
long lingering disease, chronic in form, which after a 
long and tedious course the thread of life is finally 
broken, and we hardly know the instant at which the 
change was completed. For others, it is the short, acute 
attack, which snaps the life away in a very instant, 
only after a very short duration. For some it is to die 
from accidental causes, while for others it is only the 
passing out from the period of old age. For some the 
mind may be active and the intellectual faculties useful 
up to the last moment, while for others the contrary 
is all but too true. 

Although there may be many different kinds of 
disease infecting the human race, yet we find that death 

155 



156 MODES, SIGNS AND TESTS OF DEATH. 

ultimately results from the stoppage of any one, or may- 
be, all three of the vital organs, namely the heart, brain 
or lungs. Anything whatsoever which plays upon the 
body, to such an extent, as to affect the functions abso- 
lutely, of either the heart, brain or lungs, will result 
in the death of that body. And since these organs are 
of such vital importance to us, and since the stoppage 
of any one of them will result in death, they have been 
termed the vital organs. 

Modes of Death. — There are, then, only three modes 
of death : syncope, or the stoppage of the heart ; coma, 
or the failure of the brain to perform its functions; ap- 
nea, or the stoppage of the lungs. 

Syncope. — For the heart to properly perform its 
function, namely that of propelling the blood to all parts 
of the body, it must first be properly nourished itself. 
If for any reason the heart does not get this proper 
nourishment, say the coronary arteries should become 
clogged, or a fatty infiltration, or a lack of red blood cor- 
puscles, we would have a condition in the body known as 
anemia. 

The heart must also have a proper nerve supply from 
the brain, and if because of any disease, the vaso-motor 
or the vaso-constrictor fibers should become affected, 
the heart would cease to contract and expand, and hence 
the complete stoppage of the heart. A condition of this 
kind is known as asthenia. 

But whether it is death by anemia or asthenia, the 
state of suspended animation, common to both these forms 
is expressed by the single term — syncope. 



MODES, SIGNS AND TESTS OF DEATH. 157 

Coma.^-hi cases of apoplexy, where we have the blood 
escaping from the ruptured vessels, compressing the brain, 
we find death ensuing. Also in accidental cases such 
as fracture of the skull, the injury will often cause death. 
These are examples of coma, and can be explained in 
this way, viz. ; the power of the brain becomes inactive 
either through the result of an injury or a disease, and 
when this inactivity occurs the respiratory apparatus sub- 
sides and the heart deprived of its normal stimulus 
through the vaso-motor and constrictor fibers, soon ceases 
to beat, and death is the result. 

Apnea, Asphyxia. — If for any reason the supply of 
oxygen is cut off from the lungs, we will have the body 
dying the result of asphyxia or apnea. The most common 
forms found of this mode of death are those of hanging, 
drowning or coal gas poisoning. 

Signs of Impending Death. — The signs of impending 
death are those conditions which exist on the body or 
the peculiar features of the body which aid the physi- 
cian in ascertaining the exact condition of the body. 
These signs assume many different forms and in no two 
instances may they be found alike. They of course, are 
not positive in themselves, but are sufficient to guide us 
in forming an opinion as to the approach of death. 

One of the first signs to be noticed is the coldness of 
the extremities. In this case the coldness begins at the 
extreme tips of the fingers and toes and gradually ex- 
tends toward the trunk. This, of course, is due to the 
gradual diminishing activity of the heart to propel the 
blood to the extremities. 



158 MODES, SIGNS AND TESTS OF DEATH. 

The brain also fails to receive its proper blood supply 
and becomes weakened and we find the mind wandering. 
This wandering results in the patient going through 
movements representing the playing with flowers, or pick- 
ing at the bed clothing. A further result of this weakness 
is that the patient may have visions of angels and heaven. 

Speech begins to grow thick, and a large lump of 
phlegm gathers in the throat. 

The hands now feel cold and clammy, and if they 
are raised they instantly fall. One cannot detect the act 
of respiration, as the movements of the thoracic walls 
are so slight as to be scarcely perceptible. 

The heart loses its power to propel the blood and 
the stoppage of every organ in the body ensues. 

The eyes become fixed with a staring look as though 
they were not focused on anything directly. The eyes 
lose their lustre on account of the lachrymal glands re- 
fusing to secrete. 

The vital organs, the heart, brain and lungs come 
to a halt, and we find the body passing from life to the 
great beyond. 

Tests of Actual Death. — From the large number of 
statistics that have been gathered together for our pur- 
pose, we find that the time of greatest mortality is in 
the early morning hours between three and six A. M., 
for it is between these hours that the body is in a perfect 
state of relaxation, and at the lowest ebb of vitality. 

The time of least mortality is between the hours of 
eleven and two P. M., as the body is in a relatively high 
state of vitality during these hours. 



MODES, SIGNS AND TESTS OF DEATH. 159 

The tests of actual death can be placed in two classes, 
the common tests and the expert tests. 

The common tests are those that have long been used 
by the inexperienced to ascertain the fact of death. They 
are not necessarily conclusive in themselves, but when 
all are taken together there can not be much doubt. 

(a) The Feather Test. — In this test a feather is 
held to the nostrils to observe whether it moves. The 
feather being so light, the slightest respiration of the 
lung would be apt to move it. 

(b) The Mirror Test. — In this test a mirror is held to 
the mouth and nostrils. If moisture collects on the mirror 
it is evident that respiratory movements are going on. 
If there is an absence of moisture we are quite safe in 
saying that the patient is dead. 

(c) The Bandage Test. — In this test a bandage is 
placed around the arm and then twisted very tightly. 
If there is the slightest circulation existing in the body 
the blood will accumulate back of the bandage in the 
venous system and thus demonstrate the fact. There 
will also be no swelling or discoloration beyond the 
ligature. 

(d) By placing the ear to the chest over the heart, 
no sounds will be heard. 

(e) If the ear is applied over the lungs,, no sounds 
will be heard. 

(f) If a cup of water is placed on the chest there 
will be no movement of rays or ripples on the surface. 

(g) If the skin is cut, no blood will flow, nor will the 
wound close. 



160 MODES, SIGNS AND TESTS OF DEATH. 

(h) If heat, say for instance a burning match be 
applied to the skin it will not blister, or if ammonia is 
hypodermically injected under the skin there will be no 
redness, but rather the skin will turn to a yellowish 
color. 

(i) The living hand when held to the light shows 
pink through the inner edges of the fingers, but with 
the dead hand it shows opaqueness. 

(j) When a strong light is brought before the eye 
the pupil of the eye will not dilate or contract. 

(2) The expert tests are those which a doctor or 
coroner might use to ascertain the fact of death. These 
tests are made with the stethoscope and the ophthalmo- 
scope. 

(a) By the use of the stethoscope the physcian can 
hear the sounds of the heart and if there is the slightest 
sound he can detect it. In the absence of any sound the 
body is pronounced dead. 

(b) -By the use of the ophthalmoscope the physician 
is enabled to look into the pupil of the eye and if there 
is life he can see the blood circulating through the tiny 
capillaries of the retina. If he does not see this capillary 
circulation he is quite safe in saying the body is dead. 

(c) Another method consists in the hypodermic or 
intravenous injection of certain substances, and ascer- 
taining whether these substances have been dispersed 
throughout the body. If they have, then a circulation 
exists and life continues, although the pulsation of the 
heart may not be detected by auscultation. Among the 



MODES, SIGNS AND TESTS OF DEATH 161 

substances recommended for injection are fluorescin, 
sodium iodide, lithium iodide and potassium ferro-cyanide. 
The injection of the small quantities as used will not 
cause death should the patient still be living. 

Fluorescin is usually injected, one gramme dissolved 
with an equal weight of sodium carbonate in eight cubic 
centimeters of water, and the whole quantity injected 
hypodermieally. If the circulation is persisting, the 
skin and the mucous membranes after a very few minutes 
assume a greenish color; about twenty minutes after 
the injection, the portion of the eye within the iris as- 
sumes a green color from penetration of the fluorescin 
into the vitreous and aqueous humors, and in the blood 
the fluorescin may be detected by the following method: 
One or two threads of cotton are passed under the skin 
in the form of a seton, and when saturated with blood are 
transferred to a test tube, and boiled with a little water. 
As the liquid clears the green color of the fluorescin be- 
comes evident, if that substance has been absorbed into 
the blood. 

(d) Another method for the distinction of real from 
apparent death consists in picking up a fold of the skin 
and compressing it with a pair of artery forceps. If the 
skin does not completely settle down, and if the fine 
furrows produced by the teeth of the forceps continue 
indefinitely, then death has occurred. Whereas, if the 
circulation is continuous, the fold and the marks of the 
forceps would disappear. Moreover, if death has oc- 
curred the portion of the skin compressed by the forceps 
assumes a parchment-like appearance. 



162 MODES, SIGNS AND TESTS OF DEATH 

(e) The electrical current affords a means of deter- 
mining death. It is now known that the muscles, after 
cadaveric rigidity has set in, do not respond to electric 
stimuli. The faradic current will cause, when death has 
occurred, muscular contractions until a short time before 
post-mortem rigidity occurs. The faradic stimulus is lost 
first and the galvanic stimulus soon after. We may be 
enabled to approximate the time at which death occurred, 
for, if we find any response to either the faradic or the 
galvanic current, we know at once that post-mortem 
rigidity has not yet occurred. 

No person should be buried as long as the muscles 
contract when stimulated by either the faradic or the 
galvanic current. If the electrical test were always ap- 
plied before a death certificate was signed, there would 
be absolutely no possibility of a person being buried alive 
and the public would soon lose the morbid fear of such 
an occurrence. 

Later and More Positive Signs. — (a) After a few hours 
the blood gradually sinks to the dependent parts of the 
body giving a reddish-blue discoloration, known as post- 
mortem discoloration, or cadaveric lividity. 

(b) The eyes become sunken in the sockets, the eye 
balls become flattened, the cornea opaque and the pupil 
irregular in shape. 

(c) The eyelid loses its elasticity, and the white trans- 
parent color of the conjunctiva is lost, often becoming 
black or gray. 

(d) Rigor mortis may or may not be present. 



MODES, SIGNS AND TESTS OF DEATH 163 

(e) The body gradually cools to the temperature of 
the surrounding atmosphere. 

(f) ' On opening an artery it is generally found to 
be empty after death. 

(g) The latest and most positive sign of all is putre- 
faction, and when this is found to be present all other 
signs may be ignored. 

(h) Skin slip present on the body is only another 
manifestation of putrefaction, and also signifies that the 
body is dead. 



v 



CHAPTER XI 

PREMATURE BURIAL. 

Premature Burial. — In this enlightened age, with our 
knowledge of respiration and the circulation of the blood, 
with our complete mastery of the phenomena of death 
with scientific tests, it is absolutely impossible to have 
such a thing as a premature burial. 

Nevertheless from the earliest times the fear of prema- 
ture burial has been felt by many, and curious and strange 
methods have been adopted to prevent the possibility of 
individuals being consigned to their graves before life 
was extinct. 

Tradition records many cases where, in spite of their 
precautions, such unfortunate actions have happened. It 
may be that tradition is an uncertain and erring guide. 
And yet underlying all tradition, as Dieulafoy said, is a 
solid substratum of truth which the thoughtful investi- 
gator must take into consideration. The tale of the 
Cologne goldsmith's wife, that survives in the legend of 
the neighing horses, may be weird, bizarre, and from a 
scientific point of view, demonstratively ludicrous, but 
its germ is to be found in the recorded fact that in times 
of epidemics, when the dying were huddled away with the 
164 



PREMATURE BURIAL 165 

dead, mistakes did occur, and one or two were rectified 
by the resurrection of the ' ' dead. ' ' In cases where burial 
took place in commodious family vaults, the changes in 
the position of the coffin, produced by atmospheric and 
other physical factors and were startlingly disclosed when 
the vaults were opened to receive new bodies, doubtless 
gave an impetus to the belief in the comparative frequency 
of such mistakes. The medical man remembers that on 
occasions he has found it difficult, without applying some 
of the common and finer tests, to certify death in a 
natient dying of a lingering disease, but his knowledge 
forbids him believing that such difficulties as he may 
have experienced in his own practice can ever have 
caused his fellow practitioner to make so grievous a mis- 
take in a similar case. The public has no such knowledge ; 
it relies on the exceptional cases and glibly credits the 
statement — true enough in a limited sense that there is 
no certain proof of death. While it is certainly true that 
no single sign can be absolutely relied upon to prove that 
life is extinct, all practitioners will agree that several 
signs taken in combination and methodically applied are 
sufficiently accurate to obviate the possibility of mistake. 
Much has been made of the cataleptic condition and the 
probability of mistaking it for death, which has formed 
the basis of one of Poe's narratives. As a matter of 
fact, catalepsy, of such a nature as to be confounded 
with tota exitus, is extremely rare — so rare that we 
doubt if any practitioner with a large experience of ner- 
vous conditions has met with more than one or two in- 
stances. Further, even in such extremely rare conditions, 



166 PREMATURE BURIAL 

the usual tests are applicable and to the trained medical 
man at least clearly prove the nature of the case. The 
stethoscope and the mirror held in front of the patient's 
mouth are usually sufficient to demonstrate that the pa- 
tient is alive and we should want more conclusive evi- 
dence than such as has been brought forward up to the 
present, to feel that cataleptic patients have been con- 
signed to their coffins before life was totally extinct. 

Newspaper writers delight in the fictitious and mar- 
velous, and without any regard whatever to the scientific 
phase of the subject, frequent mention of cases of prema- 
ture burial is to be found almost daily in the press of 
the country. But upon investigating these newspaper 
stories, it will be found that they have been either ori- 
ginated in the fertile brain of some reporter or were 
merely published to consume space. 



CHAPTER XII. 

THE CHANGES IN THE BODY AFTER DEATH. 

Cooling of the Body. — The internal temperature of the 
healthy living being is about 37 degrees centigrade. But 
it may be increased several degrees in consequence of dis- 
ease. After death the chemical changes upon which the 
maintenance of this temperature depends rapidly dimin- 
ishes, and the body gradually cools to the temperature of 
the surrounding atmosphere. This usually occurs in from 
about fifteen to twenty hours, but the time required de- 
pends upon a variety of conditions. Immediately after 
death there is, in nearly all cases, a slight elevation of 
internal temperature, owing to the fact that the meta- 
bolic changes in the tissues still continue for a time, while 
the blood ceases to be cooled by passing through the lungs 
and peripheral capillaries. After death from certain dis- 
eases yellow fever, cholera, rheumatic fever, and tetanus, 
a considerable elevation of internal temperature has been 
repeatedly observed. 

The time occupied by the cooling of the body may 
be prolonged after sudden death from accidents, acute 
diseases, apoplexy, and asphyxia. A number of cases is 
reported in which the body retained its heat for several 
days without known cause. 

167 



168 THE CHANGES IN THE BODY AFTER DEATH 

After death from wasting chronic diseases, and in 
some cases after severe hemorrhage, the cooling of the 
body is very rapid, the internal temperature being re- 
duced to that of the surrounding air within four or five 
hours. 

Fat bodies cool less quickly than lean ones, the bodies 
of well nourished adults less quickly than those of child- 
ren or old persons. The temperature of the surrounding 
atmosphere, the degree of protection of the body from 
currents of air, of course, modify the progress of cooling ; 
and the internal organs naturally retain their heat longer 
than the surface of the body. The rate at which cooling 
occurs is most rapid as a rule, during the hours immediate- 
ly following death, notwithstanding the postmortem rise 
which may ensue. 

Cadaveric Lividity. — This means the black and blue 
discoloration from the effects of the congestion or con- 
tusion of the blood. 

After life becomes extinct, and before the blood coagu- 
lates, it changes its position chiefly in two ways: First, 
it is driven by their contraction out of the arteries and 
into the veins; second, it settles in the veins and the 
capillaries of the more dependent parts of the body, 
inducing, usually within a few hours after death, a mott- 
ling of the surface with irregular livid patches. These 
patches may coalesce, forming a uniform dusky red color 
over the back of the trunk, head and extremities, and 
sometimes over the ears, face and neck. The same effect 
is noticed on the anterior aspect of the body if it has 
lain on the face. At points of pressure, from the folds in 



THE CHANGES IN THE BODY AFTER DEATH 169 

the clothing, and from the weight of the body on the 
bed or the cooling board, the red color is absent or less 
marked. This to the undertaker and the embalmer is 
known as postmortem discoloration. These changes 
occur before putrefaction sets in. This cadaveric lividity 
should not be mistaken for the antemortem ecchymoses 
from which it may usually be distinguished by its posi- 
tion and extent by the fact that the surface of the skin 
is not elevated, and by the fact that on incision no blood 
is found free in the interstices of the tissues. Not in- 
frequently the subcutaneous tissue in the neighborhood 
of these postmortem discolorations become infiltrated 
with a reddish serum. Very soon after death, particular- 
ly in warm weather, the tissues immediately around the 
subcutaneous veins of the neck and the thorax and in 
other situations, may become stained a bluish red color 
from the decomposition and escape from the vessels 
of the coloring matter of the blood. This to the under- 
taker and the embalmer is known as postmortem dis- 
coloration. 

Putrefactive Changes. — As soon as the body dies, it 
becomes as any other inanimate object, subject to putre- 
faction and decay. 

The tissues of the body undergo various changes 
as to consistency of the solids, semi-solids, fluids, and as 
to color. 

Putrefactive changes are caused by the presence of 
putrefactive germs normally present in the tissues or gain- 
ing access to them, which in their effort to satisfy their 



170 THE CHANGES IN THE BODY AFTER DEATH 

own nutrition, break down those complex molecules of 
which the tissues are composed into simplar compounds. 

Putrefaction then is organic decomposition or decay 
the result of putrefactive bacteria. Putrefaction may also 
be denned as the separating of the constituent elements of 
the body due to the presence and growth of bacteria. 

Although septic changes may take place before the 
death of a body, yet the term putrefaction is not applied 
until after the death of a body, and denotes those changes 
in color, consistence, and smell so clearly perceptible. 

Usually in from one to three days, depending upon 
circumstances, a greenish discoloration of the skin occurs 
at first upon the middle of the abdomen, over which it 
gradually spreads, assuming a deeper hue, and often 
changing to greenish purple or brown. Greenish patches 
may now appear on the different parts of the body, 
earliest upon those overlying the internal cavities; this 
discoloration is probably produced by the action on the 
haemoglobin of gases developed by decomposition. 

The eyeballs now become placid and if the eyelids 
are not closed the conjunctiva and cornea become brown 
and dry. The pressure of gases developed by decom- 
position in the internal cavities not infrequently forces a 
greater or less quantity of frothy, reddish fluid or mucous 
from the mouth and nostrils, distends the abdomen, and, 
if excessive, may lead to changes in the position of the 
blood in the vessels and even a moderate amount of dis- 
placement of the internal organs. 

After five or six days, under ordinary circumstances, 
the entire surface is discolored to a green or a brown. 



THE CHANGES IN THE BODY AFTER DEATH 171 

After this the epidermis becomes loosened through the 
formation of gases and separating of fluids beneath, and 
the tissues become flaccid. 

The abdomen and the thorax may be greatly dis- 
tended, and the features distorted and scarcely recogniz- 
able from swelling, and the hair and nails loosened. 

On the interior of the body, those soft and less com- 
pact tissues, or those tissues in which there is a great 
amount of fluid, are the first to decompose. This may be 
noticed by examining the walls of the trachea, esophagus 
and the intestines and noting the change in color. 

Decomposition of the soft and liquid portions of the 
body take place almost immediately after the death of 
the body, and then follow in rapid succession the decom- 
position of the semi-solids and finally the solids. Beyond 
this stage of putrefaction, the consecutive changes can 
scarcely be followed with accuracy. 

The putrefactive changes can not be said to begin at 
the same place in all bodies, as the conditions under which 
death occurred will regulate that. The rapidity with which 
these changes follow one another depends upon a variety 
of conditions such as temperature, moisture, access of air 
and the diseases which have preceded or caused death. 

Various temperature relations will effect greatly the 
more or less rapid decomposition of the body. Bodies 
dying in mid-summer are decomposed much more quickly 
than those dying in mid-winter. 

Moisture added to the temperature relation will hasten 
the rapidity of the decomposition as can be noticed in 



172 THE CHANGES IN THE BODY AFTER DEATH 

those localities with a high temperature but moist cli- 
mate that the decomposition takes place very quickly. 
In those climates with high temperature, but dry or ab- 
sence of moisture, the tendency is to dry up the tissues, 
and instead of putrefaction we have mummification as 
the result. This last statement then serves to explain 
the reason for the high state of preservation in the forms 
of mummification as exists in those countries like Egypt 
with their extremely hot and dry climates. 

Exposure added to the temperature and the moisture 
relations adds greatly to the rapidity of the decomposi- 
tion. A moist climate with a hot temperature and free 
exposure favors rapid decomposition. We notice that 
putrefaction progresses much more rapidly in the air than 
in the water and in the earth its progress is slower than 
in the water. The more exposed a body is then, to the 
elements, especially the air, the more rapid will be the 
decomposition. 

An elevated temperature and the presence of air and 
moisture hasten the advent and progress of putrefactive 
changes. 

Bodies dying in high fever and edematous subjects 
are much more quickly decomposed than those dying 
with the ordinary wasting away disease. 

The bodies of infants usually decompose more rapidly 
than those of adults, fat bodies more rapidly than lean 
ones. 

The infectious diseases, intemperance, and the puer- 
peral condition promote rapid decomposition as also does 
death from suffocation. 



THE CHANGES IN THE BODY AFTER DEATH 173 

Poisoning from arsenic, alcohol, antimony, sulphuric 
acid, strychnine and chloroform may retard the progress 
of decay. 

It is impossible, then, to say how long a body will 
keep without the use of preservatives, as it depends partly 
upon temperature, partly upon moisture, partly upon the 
amount of exposure and partly upon the conditions exist- 
ing in the body before death. 

We can easily understand the reason for all this if we 
understand the bacteriology relating to the subject. 

In the first place, bacteria require for their best and 
most rapid growth the proper temperature, moisture and 
media relations. By this we mean that the temperature 
should be moderately warm, ranging from about forty to 
one hundred degrees Fahrenheit, the optimum being about 
the body temperature 98.6 degrees Fahrenheit or 37 de- 
grees on the centigrade scale. With this optimum tem- 
perature, the element of moisture should always be pre- 
sent, as we find that nothing in nature will germinate 
without the necessary moisture. Then the bacteria must 
have the proper media, meaning that they must have the 
right substance on which to grow. Inasmuch as the 
cause of putrefaction is the host of putrefactive bacteria 
which abound trying to satisfy their own nutrition, and 
since these bacteria require a moderately warm and moist 
media on which to grow, it is only natural that putre- 
faction and decomposition should occur much more rapid- 
ly in warm moist climates than in dry cold climates. 

In regard to exposure we learn that certain putre- 
factive bacteria are aerobic in character, i. e., that they 



174 THE CHANGES IN THE BODY AFTER DEATH 

need a great quantity of oxygen for their growth, and 
for this reason a body in water or buried in the earth 
does not decompose as rapidly as one exposed to the air. 
But although they do not decompose as rapidly yet 
we find that they do decompose in time. This is due 
to the fact that there is another class of bacteria, called 
anaerobic, i. e., which do not need oxygen for their growth. 
In the case of the body in water these anaerobic bacteria 
exist and develope slowly in the alimentary tract, and 
eliminate gases sufficient to bring the body to the sur- 
face, where the aerobic bacteria enter, and putrefaction 
progresses much more rapidly. 

The starting point of decomposition is usually at the 
seat of the disease the subject had before death, but it 
soon spreads to all the various tissues of the body. 

Putrefaction is always accompanied by a great amount 
of odor, which is caused by the generation of gases the 
result of bacterial action. The obnoxious gases, offensive 
to the smell are sulphureted hydrogen, nitrogen, carbonic 
acid and ammonia. 

The material actually present when the body is actual- 
ly decomposed has been determined as being water, nitro- 
gen, methane, carbon dioxide, etc. 

Treatment by the Embalmer. — Putrefaction always 
means that there is present a great amount of putre- . 
factive bacteria and if you are to arrest this condition 
you must resort to the most thorough embalming. By 
placing some preservative fluid in the arteries and having 
a thorough circulation all the tissues of the body can be 



THE CHANGES IN THE BODY AFTER DEATH 175 

reached and hence the complete destruction of those 
bacteria causing the putrefaction. 

If all the tissues are properly bathed with embalming 
fluid there need be no further danger of putrefaction; 
but what seems sometimes at first a thorough circulation, 
proves afterward to be only a partial one. If after several 
days the body still shows signs of decomposition it is 
best to reinject or if the decomposition only occurs in spots 
a simple hypodermic injection will prove adequate. 

Skin Slip. — To properly understand the causes of skin 
slip a thorough knowledge of the structure of the skin is 
necessary. It would be best then to turn to the chapter 
on the tissues of the body and study the minute structure 
of the skin. 

Skin slip is caused by a putrefactive softening of the 
epidermis. There is a watery infiltration from the min- 
ute capillaries and the surrounding tissues between the 
dermis and the epidermis, causing the latter to loosen and 
if touched to slip and tear away from the dermis or true 
skin. 

Many embalmers have been led to believe that the 
slipping of the skin is due to the use of certain fluids 
used in injecting the arterial system. This error should 
be corrected, as it is most generally the absence of the 
fluid from the part which results in the slipping of the 
skin. 

Diseases of the heart, liver, kidney and dropsical 
conditions predispose to the early skin slip. The immense 
amount of water occurring in the minute capillaries of 



176 THE CHANGES IN THE BODY AFTER DEATH 

the skin prohibits the embalming fluid from reaching 
the tissues. 

Skin slip then is due to putrefactive changes occurring 
in the skin, and if it should occur after embalming, it is 
positive proof that the part or parts have not received a 
sufficient quantity of a preservative fluid. 

Treatment by the Embalmer. — In the average case 
you will neyer see skin slip, because you will be called 
comparatively soon after death has occurred and the body 
will be embalmed and buried before this later form of 
putrefaction will manifest itself. But in some few cases 
you will have to keep the body for a greater length of 
time, say to await the arrival of some friend living abroad, 
or it may be a coroner's case. In cases like this the 
body being kept for a period of weeks, will if it is not 
perfectly embalmed show signs of skin slip. As has 
been stated above, cases that die from diseases causing 
dropsical infiltration in the subcutaneous tissues should 
also be handled carefully. If you are aware before hand 
that you are to keep the body for a great length of time 
or that you have a dropsical subject, a little formal- 
dehyde should be added to the fluid that is injected, about 
two or three ounces to each quart of fluid. Zinc com- 
pounds might be added, but formaldehyde is better be- 
cause of its great affinity for water. 

If skin slip occurs after the body is embalmed it is 
best to place a layer of cotton over the part where the 
skin slip occurs and saturate the cotton with equal parts 
of alcohol, formaldehyde and glycerine. 



THE CHANGES IN THE BODY AFTER DEATH 177 

In drowned cases where all the skin is slipping it is 
best to envelope the whole body with a layer of cotton 
saturated with formaldehyde. 

Rigor Mortis. — Rigor mortis is the stiffening condi- 
tion which occurs on the body after death. 

When the muscle substance dies it becomes rigid, or 
goes into a condition of rigor ; it passes from a fluid to 
a solid state. The rigor that appears in the muscles after 
somatic death is designated usually as rigor mortis, since 
its occurrence explains the death stiffening in the cadaver. 
It is characterized by several features : the muscles be- 
come rigid, they shorten, they develope an acid reaction, 
and they lose their irritability to stimuli. 

After the death of an individual the muscles enter 
into rigor mortis at different times. Usually there is a 
certain sequence, the order given being the jaws, neck, 
trunk, upper limbs, lower limbs, the rigor, therefore, 
taking a downward course. The actual time of the ap- 
pearance of the rigidity varies greatly, however; it may 
come on within a few minutes or a number of hours may 
elapse before it can be detected. 

Death after great muscular exertion, as in the case 
of hunted animals, or soldiers killed in battle, is usually 
followed quickly by muscle rigor. Death after wasting dis- 
eases is also followed by an early rigor, which in this 
ease is of a more feeble character and shorter duration. 

Certain drugs such as veratrum, hydrocyanic acid, caf- 
feine and chloroform, will hasten the development of 
rigor. 



178 THE CHANGES IN THE BODY AFTER DEATH 

People who die in full habit, meaning that there has 
been no muscular exertion or wasting processes before 
death, usually have the rigor developing more slowly and 
of a longer duration. 

After a certain interval, which also varies greatly, 
from one to six days, the rigidity passes off, the muscles 
become soft and flexible ; this phenomenon is known as 
the release of the rigor. 

The usual explanation that is given of rigor is that it 
is due to a coagulation of the fluid substance, the muscle 
plasma, of which the fibers are constituted. During life 
the fluids exist in a liquid or viscous condition; after 
death they coagulate into a solid form. 

Rigor mortis is not a sign of death, as there is rigid- 
ity of the muscles following apparent death, as in cases 
of asphyxia and trance. If the body is rigid, in a case 
in which there is a doubt that death is present the rigid- 
ity may be broken up. If it is a case of trance or that of 
the contraction of the muscles following drowning, it is 
likely to return, especially in case of trance ; but if death 
is actually present it will not return. 

The chemical changes occurring, the result of rigor 
mortis can be briefly stated : 

(a) There is a coagulation of the proteid material 
of the muscle plasma. 

(b) There is an increased acidity, which is doubt- 
less due to the production of lactic acid. 

(c) There is a production of carbon dioxide. 

(d) There is a consumption of glycogen. 



THE CHANGES IN THE BODY AFTER DEATH 179 

Treatment by the Embalmer. — Many times when 
called to embalm a subject you will find the body in a state 
of rigor. In cases of this kind the rigor mortis should be 
broken up. This can be done by taking each of the joints 
and gradually bend them a little at a time until they be- 
come perfectly lax. Once a joint is bent the stiffening 
disappears and the embalmer can proceed. 

Fermentation and the Production of Gas. — A molecule 
is the smallest portion of a compound which can exist 
by itself. 

An atom is one of the ultimate particles composing a 
molecule. A complex molecule is one in which two or 
more elements have been combined. Example : water 
molecules are formed by two atoms of hydrogen and 
one atom of oxygen. 

A ferment is a substance causing fermentation in 
other matter with which it comes in contact. There are 
two kinds of ferment expressed by the names organized 
and unorganized. 

Unorganized ferments are chemical substances having 
the power to produce or assist in the production of fer- 
mentation. 

Organized ferments are bacteria having the power 
to produce fermentation. 

Fermentation means the process through which com- 
plex molecules are decomposed and their ingredients dis- 
associated by the action of ferments. As an example of 
fermentation, we can take proteid food substances, the 
molecules of which are always of complex form, and 
by subjecting them to the action of organized ferments 



180 THE CHANGES IN THE BODY AFTER DEATH 

(bacteria), decompose them, and separate each gas in- 
gredient, obtaining therefrom a variety of gases from 
what was formerly a substance of perfect chemical union. 
Fermentation is present in most of the natural processes 
whereby chemical changes are produced in animal and 
vegetable matter. Fermentation is taking place all the 
time in all the climes excepting possibly the frigid zones. 
The organized ferments (bacteria) are subject to the same 
temperature limits that govern the reproduction and the 
growth of all bacteria. 

Fermentation is divided into spirituous fermentation, 
digestive fermentation, metabolic fermentation, and pu- 
trefactive fermentation. 

Spirituous Fermentation. — Spirituous fermentation 
is that process of fermentation by which forms of yeast 
cells, by their growth and reproduction in such complex 
substances as grapes, fruit, apple juice, grains, etc., ex- 
tract alcohol from these substances and by this process 
produce wine, cider, spirits, etc. Many times in the dead 
body, spirituous fermentation occurs. Spirituous fer- 
mentation is caused by a vegetable parasite called yeast. 

Digestive Fermentation. — Digestive fermentation is 
that process by which digestion and nutrition in the living 
body is assisted through the action of ferments called 
enzymes, acting on the food substance. This process is 
mainly one where each food particle is split up by a 
particular ferment or enzyme. After death this process 
may continue for a certain length of time and result in 
the formation of gas. Digestive fermentation is mostly 
chemical. 



THE CHANGES IN THE BODY AFTER DEATH 181 

Enzymes are unorganized ferments and are cast off 
the living body within the living body. 

Metabolic Fermentation. — Metabolic fermentation 
i$ that process by which enzymes in the tissues of the 
living body destroy the dead cells, and reduce them to 
the following gases: nitrogen (N), carbon-dioxide 
(COa), ammonia (NHs), uric acid, and other materials. 
In the living body these gases and other products are 
eliminated from the tissues, by the sudoriferous glands 
and ducts through perspiration, by the lungs with the 
expired air, by the intestines with the feces and by the 
kidneys with the urine. In the dead body the enzymes 
become active agents in tissue gas production, unless 
they are kept in restraint by being brought in contact 
with germicidal embalming fluids. 

Putrefactive Fermentation. — Putrefactive fermenta- 
tion is the process by which undigested food substances 
(principally proteids), under the influence of ferment 
bacteria, yield gases. This change rarely takes place in 
the small intestines of the living body as the germs are 
held in restraint by lactic acid and acetic acid bacteria in 
those parts. There is little restraint to their activity in 
the large intestines, however, and the intestinal gases 
along with putrefactive changes in fecal material are a 
natural consequence. 

Intestinal fermentation is hastened in the dead body 
by the presence of much undigested food and the ab- 
sence of any restraining organisms. The gases produced 
in the intestines of either the living or dead body by the 
action of putrefactive ferment bacteria are : carbon- 



182 THE CHANGES IN THE BODY AFTER DEATH 

dioxide (CO*), hydrogen (H), nitrogen (N) hydrogen 
sulphide (EkS), methane (CIL). The continued fer- 
mentation in the stomach and the intestines causes a 
coffee colored material of a frothy character to purge from 
the mouth. 

When the hollow needle or trocar is used to reach the 
scene of ferment activity, the gases mentioned are re- 
leased from the effected organs. As these gases are ex- 
tremely odorous, they should be passed through a pled- 
get of cotton saturated with formaldehyde, before being 
allowed to pass into the open air. Germicidal fluids 
when directed against the bacteria in an intelligent man- • 
ner should destroy them and prevent their becoming ac- 
tive again. 

Putrefactive fermentation is divided as follows: ab- 
dominal fermentation, gastric fermentation, and intes- 
tinal fermentation. 

Abdominal Fermentation. — Abdominal fermentation 
is putrefactive fermentation as it effects the tissues and 
necrotic substances of the abdominal cavity itself (except- 
ing the digestive organs), caused by the action of zymo- 
genic bacteria. Perforations of the intestines or appendix, 
inflammation of the mesentery or peritoneum, may allow 
putrid material to escape into the cavity proper, where 
bacterial action will produce noxious gases. You will 
recognize a condition of this kind by the following illus- 
tration: As soon as the point of the trocar has pene- 
trated the peritoneum and the rod has been withdrawn, 
there will be an escape of gas. This escape is due to the 
internal pressure being greater than the atmosphere pres- 



THE CHANGES IN THE BODY AFTER DEATH 183 

sure. This explains the swollen condition of the abdomi- 
nal wall and its subsequent relaxation as the gas is allowed 
to escape. 

Certain diseases predispose to abdominal fermenta- 
tion as inflammatory diseases which effect the peritoneal 
covering of the organs, and cause a swollen abdominal 
wall after death. 

Treatment. — In the treatment of these cases it is al- 
ways advisable that the operator be familiar with the 
location of the disease, so that direct trocar application 
can be made to the affected part. The location of the 
affected part is not always the same, as it varies with 
the location of the particular tissue or organ affected. 
In appendicitis, where death has occurred without surgi- 
cal attempts to remove the appendix, the operator should 
spray the right inguinal space with enough fluid to 
neutralize the cause of the gas. Where the cause of 
death has been typhoid, the umbilical, hypogastric and 
epigastric spaces should be sprayed. Where the cause 
of death is puerperal fever, the right and left inguinal 
and hypogastric spaces should be sprayed. The gas it- 
self, will be eliminated from the cavity of the body by 
cimply inserting the trocar and allowing the gas to es- 
cape until the internal pressure approximates that of the 
atmospheric pressure. This though does not prevent the 
reformation of gas, as the origin of the gas is the living 
and growing fermentative and putrefactive bacteria. To 
prevent a recurrence the bacteria must be killed, and 
this is done by spraying a germicidal fluid around the 
affected part. Abdominal fermentation and gas is much 



184 THE CHANGES IN THE BODY AFTER DEATH 

easier to treat than gastric or intestinal fermentation. 

Gastric Fermentation. — This is recognized by a frothy- 
coffee colored purge from the mouth or nose caused by 
pressure in the stomach, due to putrefactive bacteria, and 
their action on proteid food substances which are present 
in the stomach. Where the cause of death has been prin- 
cipally from inflammatory processes, or where the de- 
ceased has died shortly after eating a full meal, this con- 
dition must be looked forward to. The swollen condition 
directly over* the stomach is another visible sign of value 
in diagnosing the condition. 

Treatment. — When the body is placed in your care, 
the embalmer should make a careful and thoughtful sur- 
vey of the condition of the body and the cause of death. 
Any inflammatory disease of the abdominal tissues or a 
full meal eaten shortly before death will almost always 
predispose to the formation of gas. The treatment would 
be to take proper care of the stomach contents. 

(a) Insert the trocar at a point two inches to the 
left of the median line, half the distance from the ensi- 
form cartilage and the umbilicus. Direct the trocar 
downward and diagonally to the left to a depth of three 
to four inches. Remove the trocar rod and allow the gas 
to escape into a fluid bottle, containing a small amount of 
fluid, so that the gas may be deodorized. Before remov- 
ing the trocar, inject not less than one pint of normal 
fluid into the stomach, so that the fermentable materials 
and the bacteria may be destroyed. 

(b) Make an incision in the median line of the 



THE CHANGES IN THE BODY AFTER DEATH 185 

body, three inches long, from the tip of the ensiform 
cartilage downward toward the umbilicus, and proceed as 
directed for the direct incision described on page 257. 

The treatment for gastric fermentation demands the 
specific treatment as directed above. No short treatments 
can be depended upon for certain results. Cotton placed 
in the mouth only delays the time for the purging to 
begin from the mouth. Gastric fermentation can be pre- 
vented in all cases by the use of the specific treatments as 
described in (a) and (b). 

If in your practice, you receive a body from a shipping 
undertaker, which unfortunately was not treated in the 
correct manner, and which is purging from the mouth, 
arrange to puncture the stomach in the manner described 
in treatment (a). This can be done without disturbing 
the position of the body in the casket, by opening the 
clothes above the stomach. After puncturing the stomach 
and allowing the gas to escape, inject not less than one 
pint of fluid therein, cleanse the mouth with absorbent 
cotton by the use of the lock forceps and a recurrence of 
the purge will not be possible. 

If in your practice you have overlooked the possibility 
of gastric fermentation, and find, either by advice from 
the family or from your own observation, that purging is 
going on, use either the treatment (a) or (b), neutralize 
the fermentable material, cleanse the mouth and no re- 
currence will be possible. 

Intestinal Fermentation. — Here we have the ferment- 
ing gases in the intestines and the colons. The pressure 
of the gases will bear upon the stomach and there may or 



186 THE CHANGES IN THE BODY AFTER DEATH 

may not be purging from the mouth depending upon the 
fact of presence or non presence of material in the stom- 
ach. The abdomen though will be greatly distended, and 
when palpated will give a drummy note. 

Treatment. — (a) Insert the trocar through the umbili- 
cus, and direct the point downward into the right in- 
guinal region so as to relieve the gases from the caecum, 
then inject a small quantity of fluid; then direct the point 
of the trocar upward into the left inguinal region so as 
to relieve gases from the sigmoid flexure, and inject a 
small quantity of fluid; then direct the point of the 
trocar upward into the right hypogastric region so as 
to relieve gases from the hepatic flexure, and inject 
a small quantity of fluid; then direct the point of the 
trocar upward into the left hypogastric region so as to 
remove gases from the splenic flexure, and inject a small 
quantity of fluid ; and if at this time it is thought that the 
stomach contains gas, relieve it, and inject therein a 
small quantity of fluid ; now place some fluid directly into 
the abdomen around the small intestine and with this 
treatment you are assured that your intestinal fermenta- 
tion is taken care of. 

(b) Intestinal fermentation may also be treated by 
the direct incision, as described on page 257. 



CHAPTER XIII. 

DISCOLORATIONS. 

Discolorations. — Discolorations should be treated as 
a separate and independent subject because they are 
causes of great annoyance and embarrassment to the opera- 
tor, and their treatment is of utmost importance. Just 
think of the possibility of having a body properly in- 
jected, and the preservation complete, and something 
along the line of a discoloration coming to the front and 
ruin the results of the work. If there is any condition 
possible in the dead body that can cause more trouble 
to the embalmer than discolorations in general, it has not 
as yet been discovered. You have only to realize what the 
appearance of a body would be in the casket, if any dis- 
colorations were present on an exposed surface, to know 
that too much can not be said on the subject. 

Discolorations may not occur in conjunction with 
tissue changes, so when they do occur we should look for 
the cause of the same before deciding just what the 
name of the discoloration is, or what treatment should be 
given to eradicate it. 

For convenience in study, and for the proper class- 
ification of the various conditions, the subject has been 
divided into those discolorations occurring before death, 

187 



188 DISCOLORATIONS 

and those discolorations which may occur in the body 
after death. 

Discolorations Occurring before Death. — Those discol- 
orations occurring before death and which would remain 
on the body after death would be : 

(a) Yellow jaundice, 

(b) Pigmentary atrophy, 

(c) Cancerous spots, 

(d) Gangrene, 

(e) Ecchymosis or ante-mortem staining, 

(f) Wounds, fractures, scars and tattoo marks. 

(a) Yellow Jaundice. — In the study of the liver you 
have heard that the liver secretes a digestive juice called 
the bile. 

Bile acts as the natural antiseptic of the intestines in 
life, and aids with the digestion of fatty food substances 
along with other actions. The principal coloring matter 
of the bile is a yellow substance called bili-rubin. Bili- 
verdin, green, is precipitated by alkalies. 

The course of this bile in life is from the liver to the 
gall bladder, which acts as the reservoir, into the cystic 
duct and then into the common bile duct and into the 
cavity of the duodenum (first section of the small in- 
testines). It sometimes happens that there may be an 
obstruction of the bile ducts with the result that the bile 
is backed up into the gall bladder, and from there into the 
liver again, throwing it into the blood vessels of the liver 
and out into the tissues of the body along with the blood. 
As the blood traverses the entire area of the body, and 



DISCOLORATIONS 189 

as the yellow coloring matter of the bile acts as a stain, 
it is only a matter of course that the tissues will be 
stained the characteristic color of the bile. 

This stain will be found all over the body from the 
outer layer of the skin to the membrane covering the 
bone (the periosteum) and will adhere very closely to 
the tissues, rendering the removal practically impossible. 

Ordinary arterial injection of a body of this character 
will have absolutely no effect, no matter what preserva- 
tive fluid may be used and regardless of whatever any 
one may say, as it stands to reason that when the dis- 
coloration is not located in the blood vessels, that the re- 
moval of same can not be accomplished by flushing the 
blood vessels alone. 

Of course, the washing of the blood vessels with a 
solution will aid the removal of the discoloration, but 
it is necessary to employ a strong bleaching solution on 
the outer surface of the exposed parts in order to better 
the conditions so that the body may be made presentable. 

In addition to this treatment, it would be advisable 
to color the lights in the room in which the body is to be 
shown, so as to make every thing in the room about the 
same color of the body, including the persons viewing 
the remains. This will have the effect of lessening the 
apparent bad color of the body, and will add to your rep- 
utation as an embalmer. 

(b) Pigmentary Atrophy. — Here is another instance 
of the work of bile pigments or coloring matters, in which 
not only the yellow, but the green colors are deposited 
in the tissue cells. In addition to this, the cells all 



190 DISCOLORATIONS 

over the body atrophy (contract or reduce in size). The 
contraction of the cells may be due to imperfect nutri- 
tion or perhaps anemia or some other action causing great 
emaciation of the body. 

You will see very readily that the main point of diff- 
erence between yellow jaundice and pigmentary atrophy is 
in the color, and also in the fact that the cells in yellow 
jaundice are in their normal state and in pigmentary 
atrophy are in a contracted condition. The treatment 
given for yellow jaundice as follows : injecting and wash- 
ing the blood vessels with a mild solution and the ap- 
plication to the affected parts of a strong bleaching solu- 
tion, should be given for pigmentary atrophy. 

The suggestions as regarding the lights to show the 
body under, should also be noted and used in these cases. 

(c) Cancerous Spots, — What is intended for th5s 
particular discoloration, is not the ordinary cancer that 
has eaten through the skin, but that form sometimes 
noted in aged persons where the cancer is just about to 
come through the skin. In other words, a yellowish 
brown color showing in any of the exposed parts of the 
skin before death. 

As cancer is in fact a rottening or mortification of the 
tissues, the injection with a hypodermic outfit of a strong 
hardening and bleaching solution will harden and bleach 
out the color of the cancer to a great extent, and thus 
improve the appearance greatly, the ordinary cosmetic 
powders will finish the preparation. 



DISCOLORATIONS 191 

For the hypodermic injection we would suggest the 
following : 

R Alum, 10 gr. 

Corrosive sublimate, 5 gr. 
Zinc chloride, 5 gr. 
Grain alcohol, 4 fluid oz. 
Formaldehyde, 2 fluid oz. 

The cancerous spot should not be confounded with 
the color of dessication which will resemble it somewhat. 
The main point of difference would be that the cancer 
would be present before death, and the dessication could 
not possibly occur until after the body is embalmed. 
This caution is advised on account of the tendency the 
solution to be injected hypodermically would have to 
make a dried spot worse in color than better. 

(d) Gangrene. — Gangrene can best be described as 
the death of certain areas of tissue of the living body. 
The death of the tissue may be brought about by very 
many causes ; by vascular obstruction and arrest of the 
blood supply to a part, or of the outflow from a part ; by 
enfeebled circulation ; temporary stoppage of the circula- 
tion of a part or organ; acute infection; and by burns. 

Gangrene with its peculiar color, a dark green, is not 
often found on the exposed surfaces of the body, but will 
more often be found on the lower extremities and then 
only on the bodies of aged persons. For this reason it 
will be unnecessary to treat it for the removal of color. 

(e) Ecchymosis, or Antemortem Staining. — Ecchy- 
mosis is an extravasation of blood into the areolar tissues, 



192 DISCOLORATIONS 

forming a bruised place caused principally by a blow 
from a heavy instrument or missile. 

This form of discoloration is mostly seen in accident 
cases, where death was due to mechanical causes. 

In ecchymosis the blood capillaries being ruptured, 
the blood permeates the bruised tissues surrounding the 
ruptured vessels and thus gives the characteristic color 
of venous blood. There seems to be no positive treat- 
ment, but in some cases it can be remedied to some 
degree by "a hypodermic injection of a good bleacher, 
and then massaging the part with a strong bleaching 
solution. Spots of this kind can sometimes be covered 
with flesh tints. 

It is often important to determine whether violence 
has been inflicted on a body before death. In regard to 
this point, we must remember, first, that blows and falls 
of sufficient violence to fracture bones and rupture the 
viscera may leave no marks on the skin, even though 
the person has survived for several days; and, second, 
that there are postmortem appearances which simulate 
antemortem bruises. A severe contusion during life may 
present, at first, no mark or only a general redness. 
After a short time the injured part becomes swollen and 
of a red color, this color may be succeeded by a dark 
blue, and this in turn fade into a greenish yellow or 
yellow; these later appearances are due to an escape of 
blood from the vessels and to a subsequent decomposi- 
tion of the hemoglobin. If, therefore, we cut into such 
an ecchymosis after death, we find extravasated blood 
or the coloring matter of the blood, in the form of pig- 



DISCOLORATIONS 193 

ment granules, free in the tissues. Postmortem discolora- 
tions, on the other hand, although their external appear- 
ance may resemble that of antemortem ecchymosis, are 
not formed by an extravasation of blood, but by a cir- 
cumscribed congestion of the vessels or by an escape of 
blood stained serum. If you cut into such discolorations, 
therefore, we find no blood outside the vessels. Care 
should be taken not to mistake the lesions of hem- 
orrhagic infection for traumatic ecchymosis. 

Blows on the skin of a body which has been dead for 
not more than two hours may produce true ecchymosis 
with extravasation of blood, such as can be distinguished 
with great difficulty or not at all from those formed dur- 
ing life. If putrefactive changes be present, the diffi- 
culty of distinguishing between antemortem and post- 
mortem bruises is greatly enhanced. 

Hanging and strangulation are attended with the 
formation of marks on the neck which are described in 
works on forensic medicine. These marks must not be 
confounded with the natural creases of the skin of the 
neck. Many adults during life have creases of the skin 
of the neck, one or more in number, running downward 
from the ear under the chin or encircling the neck. After 
death these creases may be much more evident than 
during life, and may be rendered more decided by the 
position of the head, or if the body be frozen. They 
usually persist until the skin putrefies. 

(f) Wounds. — The embalmer should notice the situa- 
tion, extent and the direction of a wound, the condition 
of the edges, and the surrounding tissues. If it be a 



194 DISCOLORATIONS 

deep, penetrating wound, its course and extent should 
be ascertained by careful dissection rather than by the 
use of a probe. 

If the edges of a wound be inflamed and suppurating, 
or beginning to heal, it must have been inflicted some 
time before death. In a wound inflicted a short time 
before death the edges are usually everted; there may 
he more or less extravasation of blood into the surrounding 
tissues, and the vessels contain coagulated blood; but 
sometimes none of these changes occur. The chief char- 
acteristics of a wound inflicted after death are absence 
of a considerable amount of bleeding, non-retraction of 
edges, and the absence of extravasation of blood into the 
tissues. But a wound inflicted within two hours after 
death may resemble very closely one received during 
life. In general, unless a wound is old enough for the 
edges to present inflammatory changes, the embalmer 
must be very careful in asserting its antemortem or post- 
mortem character. 

(g) Fractures. — It may be important to determine 
whether a bone was fractured before or after death. 
This point can not always be decided. Fractures inflicted 
during life are, as a rule, attended with more extravasa- 
tion of blood and evidences of reaction in the surround- 
ing tissues; but fractures produced within a few hours 
after death may resemble these very closely. Usually 
a greater degree of force is necessary to fracture bones 
in the dead than in the living body. 

(h) Scars and Tattoo Marks. — The presence and 



DISCOLORATIONS 195 

character of these should be noted. Scars produced by 
any considerable loss of substance may become very much 
smaller and less conspicuous, but never entirely disappear. 
Slight and superficial wounds, however, leave marks which 
may not be permanent. 

The discoloration produced by tattooing may, although 
it rarely does, disappear during life. The embalmer 
should not try to remove it. 



CHAPTER XIV. 

DISCOLORATIONS.— -Continued. 

Discolorations Occurring After death. — Those dis- 
colorations occurring after death would be as follows: 

(a) Desiccation. 

(b) Greenish tinge of putrefaction. 

(c) Chemical action. 

(d) Postmortem discoloration. 

(e) Postmortem staining. 

(f) Capillary or venous congestion. 

Desiccation. — This is a brownish color caused by the 
drying of the skin. Various conditions might cause this 
color of which a few are considered here : 

Natural evaporation, the drying action of formalde- 
hyde, freezing the skin, feverish conditions of the body 
before death, absence of a normal amount of moisture in 
the skin of the dead body. 

Natural Evaporation. — The passage of moisture from 
the skin into a dry atmosphere reduces the normal amount 
of moisture in the skin, thereby producing an altered 
color. The extent of the moisture reduction governs the 
color produced. When evaporation begins, the skin loses 
its softness and becomes slightly yellow in color. As 
196 



DISCOLORATIONS 197 

evaporation continues the skin becomes more hard and 
the color changes from yellow to brown. At this time 
nothing can be done to restore the original color as in 
the absence of the blood circulation, the pigment of the 
skin will not take up moisture, nor will moisture pene- 
trate the skin itself. 

Treatment. — The only treatment for a condition of 
this kind is necessarily a preventive one. While embalm- 
ing a body, the operator should apply either water or 
one of the commercial face solutions to the skin of all 
the exposed portions of the body. If the condition within 
the skin is one in which there is a predisposition toward 
dryness, the face solution or the water by being present 
on the skin will reduce evaporation from the skin itself; 
in this way maintaining the natural degree of moisture. 
Should a hard, dry spot appear in the absence of any 
preventive treatment, the operator can only coat the spot 
with grease paint and thereby hide it. 

The Drying Action of -Formaldehyde. — Formalde- 
hyde is derived from methyl spirits, which in itself has 
an active affinity for water. The amount of water ordina- 
rily mixed in formalin in the compounding of a formal- 
dehyde fluid is not sufficient to satisfy the appetite of 
the formaldehyde for more water. When a formaldehyde 
fluid comes in contact with moisture laden skin, there 
will be a movement of moisture from the skin toward 
the formaldehyde fluid, thereby reducing the degree of 
moisture in the skin and in that way causing it to become 
dry. When the skin becomes dry, it changes in color 
the same as in natural evaporation. 



198 DISCOLORATIONS 

Treatment. — There are three conditions in the skin 
met by the operator. The first is where there is a pre- 
disposition toward dryness and this is where the skin 
does not contain a normal amount of moisture to begin 
with. In old age cases, tubercular, and anemic bodies, 
the ordinary embalming fluid should be diluted at least 
one half for the first part of the injection, thus reducing 
the appetite for moisture on the part of the fluid. In 
addition to this, water or a face solution should be used 
externally to prevent outward evaporation from further 
reducing the moisture in the skin. The fluid exhibits a 
tendency to draw water into the pores, thus maintaining 
to a large degree, the normal moisture percentage. 

The second condition met with is one in which the 
skin contains a normal amount of moisture. In this case 
it would not be necessary to reduce the strength of the 
standard fluid at any time during the injection, but it 
is necessary to apply water or a face solution externally 
to limit outward evaporation and to provide a source 
whereby moisture could be drawn into the pores by the 
appetite of the formaldehyde, thus again maintaining 
the normal percentage of moisture in the skin. 

The third condition is one in which the skin along 
with the balance of the body, will contain more than a 
normal percentage of moisture. This condition may be 
looked for in edematous or dropsical cases. The injec- 
tion in these cases should be normal in strength unless 
the dropsy is very pronounced, when an overnormal in- 
jection can be given without reducing the moisture per- 
centage in the skin below the normal point. 



DISCOLORATIONS 199 

Should the above precautions not be used and the 
skin be dried through the appetite of formaldehyde for 
water, no treatment can be given which will restore the 
moisture to the skin. When moisture is drawn from the 
skin and the percentage is below normal, the skin will 
shrink and will draw tight against the bones and sub- 
cutaneous tissue. This frequently gives rise to the sharp 
nose and to the drawn appearance so common in those 
cases. Prevention is the only remedy. 

Freezing the Skin. — When the body is subjected to 
a temperature of 32 degrees Fahrenheit, the moisture in 
the skin freezes, thereby removing it from its usual con- 
sideration, as the element that is responsible for the usual 
softness and flexibility of the skin. 

In the cold months, bodies are sometimes left in cold 
rooms with the windows open. The embalmer did this 
in the past, thinking that subjecting the body to the in- 
fluence of a cold atmosphere would simplify preservation. 

From the standpoint of preservation alone, this theory 
is correct, but in accomplishing the above result the 
moisture of the skin may be frozen. The resulting color 
is light yellow. The texture of the skin is changed from 
soft to a slightly hardened condition. 

Treatment. — Never allow the room temperature to 
approach the freezing point. Should the above treatment 
be disregarded, and the yellow color become present, have 
the room warmed, and the color will slowly disappear. 

Feverish Conditions in the Body Before Death. — 
Fever is the name usually given to the rise of tempera- 
ture that goes with inflammation. In severe inflamma- 



200 DISCOLORATIONS 

tory diseases, the tissues lose much of their moisture 
through the arrest of the saturating power of the blood 
stream and the disturbance of circulation. The skin con- 
tains a sub-normal amount of moisture when the embalmer 
reaches these cases, which may be further reduced by 
outward evaporation and the dehydrating power of the 
embalming fluid. Small brown spots resembling the 
fever blister in the living body may be present around the 
mouth. 

Treatment. — Use half strength fluid for the first part 
of the injection, followed by normal fluid for the second, 
third and fourth parts. Apply water or a commercial 
skin or face solution while the injection is going on. 

Absence of a Normal Amount of Moisture in the 
Skin of the Body. — The normal amount of moisture in 
the skin has been determined to be an amount equal to 
seventy-five per cent, of the weight of the skin. Any 
percentage less than seventy-five per cent, is considered 
subnormal. This condition can be expected in all fever 
cases, in anemics, and in old age. 

Treatment. — When the skin appears rather dry, the 
injection of fluid should be half strength for the first 
and second parts, normal for the third and fourth. The 
skin of the exposed parts of the body should be dampened 
with an application of water or a commercial face or 
skin solution, while the injection is being made. 

Greenish Tinge of Putrefaction. — Putrefaction discol- 
orations are those which are produced when putrefactive 
bacteria become active in the skin or subcutaneous tissue. 

This discoloration appears generally about the second 



DISCOLORATIONS 201 

day, unless preservative fluids have been applied to pre- 
vent it. It first begins in the ileocaecal region or lower 
part of the abdomen. The skin covering these parts as- 
sumes a brownish color which shades to yellow, yellowish 
green, and finally a green color. This green discoloration 
will in a few days spread all over the surface of the body. 
Among the putrefactive bacteria is the bacillus fluor- 
escens, a chromogenic germ, which produces a greenish 
color when it becomes active in the tissues. One of the 
first external evidences of putrefaction is the production 
of a greenish color in the abdominal wall. This, of course, 
could not occur when embalming had been done with any 
degree of completeness. Should an insufficient circulation 
be encountered when embalming a body, the part which 
does not receive the fluid, being unprotected, may be af- 
fected by the color producing germ mentioned above. The 
most likely to be affected by an insufficient circulation 
will be located somewhere in the extremities of the cir- 
culation, that is to say, in the skin. "We can place the 
affected part more definitely in the skin of the face, par- 
ticularly the nose, which has a rather poor circulation. 
This condition will not make its presence known until 
three or four days after embalming has been done, making 
it almost entirely absent in bodies embalmed in ordinary 
practice. Should several days elapse between the time 
the body died and embalming, allowing the discoloration 
to appear, the following treatment would be advisable : 

Treatment. — Inject a very small portion of the follow- 
ing solution just under the skin, using a hypodermic 
needle. 



202 DISCOLORATIONS 

Alum 10 gr. 

Corrosive Subl 10 gr. 

Zinc Chloride 5 gr. 

Grain Alcohol 4 fl. oz. 

Formaldehyde 2 fl. oz. 

Just a small portion of the above solution is all that 
will be necessary, working it under the skin with the 
finger tip, so as to avoid destroying the features by swell- 
ing the tissues*. 

This treatment being a chemical one, it is necessarily 
slow in its action of bleaching the green color. Should 
haste be necessary, inject a very small quantity of em- 
balming fluid to arrest the putrefactive process and then 
cover the spot with theatrical grease of the proper color 
to match the surrounding skin. 

Chemical Action. — Chemical action is any discolora- 
tion of the skin or tissues of the body which may be 
caused by the action of opposing chemicals. There is 
only one known discoloration occurring in the body after 
death as a result of the presence of a chemical in the body, 
which, when coming in contact with formaldehyde, pro- 
duces a discoloration. This particular discoloration, 
greenish in color, is the result of the work of the drug 
methylene blue in contact with formaldehyde. 

Often, in cases of chronic malaria, or diseases of the 
liver, or again as a general antiseptic, methylene blue 
will be administered by the attending physician, and you 
should learn this fact beforehand, for if methylene blue 
has been administered it is advisable not to use a formal- 



DISCOLORATIONS 203 

dehyde fluid. There is a chemical action set up between 
the formaldehyde and the methylene blue, which gives 
the tissues a greenish color, which is quite objectionable. 

In this case you would use some fluid which does 
not contain formaldehyde, benzoate of soda, or borax, 
or peroxide solution should be used. 

Another good formula to use is the following: 

Rx 

Carbolic acid 5 oz. 

Borax 12 oz. 

Glycerine 1 oz. 

Water, sufficient to make 1 gall 

or 
Rx 

Carbolic acid 5 oz. 

Oxalic acid 12 oz. 

Boracic acid 2 oz. 

Water, sufficient to make 1 gall 

Postmortem Discoloration. — This is a general ex- 
pression, and refers to any discoloration which might oc- 
cur on the body after death. 

What is usually meant, though, when this term is 
used is the settling of the blood to the dependent parts 
of the body after death. If the body is lying on the 
back, the blood will naturally gravitate toward the back, 
into the azygos system and cause a bluish discoloration, 
or the same condition will result, if the body is found 
lying on the face and stomach, in which case the discol- 
oration will be in the face and the anterior chest and 
abdominal walls. 



204 DISCOLORATIONS 

Postmortem Staining. — This condition is caused by 
changes in the blood while in the veins. The blood be- 
comes more fluid in character and the red blood cor- 
puscles become granular and give oft their oxygen which 
escapes through the walls of the veins and carrying 
with it the haemoglobin or coloring matter of the blood, 
stains the tissues over the superficial veins a purplish 
red color. This discoloration only appears on the ven- 
tral surface of the body and along the course of the large 
superficial veins. An excellent example of this discolora- 
tion is seen in the drowned subject where almost always 
all the superficial veins can be easily traced by this dis- 
coloration. 

Capillary or Venous Congestion. — This term includes 
those discoloratjions either caused by gas distension 
or by the unskillful injection of fluid into the vascular 
system. Gas forming in the abdominal or thoracic cavi- 
ties will so press upon the heart as to empty it of its 
blood, which will be forced upwards into the large venous 
trunks of the head, neck and axilla. All embalmers are 
familiar with the flushed face which often appears when 
the arterial system has been injected in a too hasty man- 
ner. It causes the veins and capillaries of the face and 
neck to become congested the same as that caused by 
the formation of gases in the cavities. 



CHAPTER XV. 

ARTERIAL EMBALMING. 

Making the First Call. — There are some pertinent 
points to consider regarding the procedure at the time 
the call is received. Many embalmers have some particu- 
lar rules that govern their inquiries at this time. It is 
the consensus of opinion among professional men of all 
kinds that a rule is a good thing to have to cover any- 
regular procedure. It matters not so much as to what 
the rule is, just so the necessary information can be ac- 
quired in a uniform manner, thus systematizing that part 
of the work and enabling the embalmer to properly pre- 
pare for the case at hand before leaving the establishment. 

The habit of inquiring about the sex, and age of the 
person, as well as the cause of death, should be cultivated. 
The importance of knowing the sex of the person lies in 
the fact that in some communities different styles of 
door badges or decorations are more appropriate for one 
sex than for the other. When the ruling decoration is 
some form of fresh flowers, this should be ordered before 
the embalmer leaves for the house of mourning if possible, 
unless the call should be received at night or in the early 
hours of the morning, when this item is usually left until 
the earliest business hour. The age of the person also 

205 



206 ARTERIAL EMBALMING 

determines to a great extent the style of decoration which 
is to be used. 

The cause of death is vitally necessary. In some 
cases, the ordinary contents of the embalmer's grip or 
hand bag are sufficient for the usual needs. In other 
cases, extra material of various kinds are necessary, for 
instance, the rubber floor covering for the carpet in drop- 
sical cases ; the sanitary clothes in eruptive contagious 
diseases ; the fumigating outfit in the same diseases, (pro- 
viding this duty is not performed by the health authori- 
ties) ; and other articles needed only in the treatment 
of special cases. 

After obtaining the above information, examine your 
grip or hand bag to see that you have all the equipment 
needed to care for the case in the proper manner. This 
saves many cases for those who follow these rules, as they 
are enabled to have just what is needed, and prevents 
the slighting of a case for which there may be some ex- 
cuse if the proper materials are not in the outfit. From 
a professional standpoint, it should be necessary for the 
embalmer to carry anything he may need, otherwise care- 
lessness may dictate his procedure and disaster may 
result. 

An ordinary case can be attended with the following 
material* : — 



♦NOTE — Many embalmers get along, some way, with much 
less in their outfit than enumerated here. The authors believe 
that the embalmer should have all the material needed to 
properly carry out his work, and anything of necessity left from 
the outfit only reduces the efficiency of the embalmer, and leaves 
him. at times, without the proper assortment of material. 



ARTERIAL EMBALMING 207 

The couch embalming board. 

The slumber robe, and face cover. 

A rubber or oil cloth cover for the board. 

A suit case grip, or hand bag. 

Concentrated fluid (at least 4 bottles). 

One or two empty 64-oz. bottles (for mixing fluid). 

One bottle for blood drainage. 

One injecting outfit (pump, tubes, etc.) 

One blood drainage outfit. 

One instrument wallet, containing: — 

2 scalpels, 1 bone separator, 2 aneurism needles, 
1 spool linen thread, 1 grooved director, 3 arterial 
tubes (assorted diameters), 1 bistoury, 1 lock for- 
ceps, 1 spring forceps, 1 artery forceps, 1 case 
needles, 1 6-inch child's trocar, 1 12 or 14-inch tro- 
car, 1 chin rest, 1 hypodermic outfit, 1 roll ab- 
sorbent cotton, 1 sponge, 1 box face powder, 1 nail 
file, 1 hair brush, 1 bottle bichloride of mercury 
tablets, 1 shaving outfit. 

For special cases it would be well to have on hand 
the following articles: — 

1 small can plaster of paris. 

1 tube lip cement. 

2 rubber bandages. 

1 can hardening compound. 

1 bottle Piatt's chlorides or any other good deodorant. 

1 outfit of formalin and permanganate of potash, or 
any other standard gaseous germicide preparation for 
fumigating. 



208 ARTERIAL EMBALMING 

1 small bottle of tincture of iodine as a preventive to 
infection should you cut yourself. 

After the outfit has been found correct for the case 
at hand, place everything in the conveyance, and leave 
for the house. Upon arriving at the house, enter alone 
and meet the member or members of the family who 
have been delegated to talk to you. At this time it will 
be well to ascertain the position of the body, the wishes 
of the family in reference to where the body is to be 
placed after embalming and to where the body is to rest 
in the casket until the time of the funeral. 

If you meet with any objection as to embalming, it will 
be well for you to consider the sanitary aspect of the 
case in speaking to those interested. In this case the 
sanitary aspect should always take precedence over the 
preservative aspect, since you can count on the assistance 
of the physicians in supporting embalming on that ac- 
count. Should your wishes be overruled after you have 
presented the facts in the matter, it would be well for 
you to place the entire responsibility for the condition 
of the body upon the family, since without embalming 
you are unable to know the final condition of the body, 
and should not be held responsible for it regardless of 
what the condition may be in that case. 

After this short talk with the family, return to your 
conveyance and carry your outfit to the room of death. 
Everything that you carry should be properly covered, 
as there is nothing quite as indecorous as the display 
of an embalming board without a cover. When you have 
placed the outfit in the room, call for everything that you 



ARTERIAL EMBALMING 209 

will need from the family, which will include such things 
as a pail, warm water, soap, towels, etc. Do all of this 
before touching the body; and after securing all the nec- 
essary items, close the door, and do not open it again 
until the work has been completed. 

Should unforeseen circumstances cause you to re-open 
the door, present yourself with a coat on, and never, 
under any circumstances, appear before any one in your 
shirt sleeves, as that is another indecorous procedure. 
After the preservation has been completed, dust a little 
face powder on the face and hands, to remove the moist, 
clammy appearance which may have been left on those 
parts. Place the undergarments on the body and then 
any other garments which may have been given to you 
by the family. Cover the body with the slumber robe, 
and then call in as many members of the family as may 
wish to view the body, asking them to criticize your 
work. Before calling in the family it would be well to 
put everything out of sight and not have any grips open. 

If favorable comment is heard from the family, your 
work is done for the time being. If unfavorable comment 
is heard, ascertain the cause of the comment and do not 
leave the house until the proper appearance has been 
secured. If your work has been pleasing to the family, 
you can rest assured that the case is a success and that 
you have done your work well. "When you are satisfied 
jn your own mind that all is well with the body, make 
arrangements for the selection of the casket, and then 
retire from the house. If the door decoration has not 



210 ARTERIAL, EMBALMING 

» 

been placed in position before you leave, you will place 
it in position yourself. 

Some funeral directors set the time for the funeral 
during the first call, and some wait until later. The same 
for the other arrangements, such as newspaper notices, 
minister, singers, church or chapel services, number of 
conveyances, etc. "Whatever method you choose to use in 
your community should be carried out systematically so 
that at no time, will anything be left undone to cause 
confusion at some inopportune time. 

The Position of the Body on the Embalming Board. — 

The position of the body on the embalming board is regu- 
lated by the adjustment of the movable head end of the 
board. 

After much experience with various classes of bodies, 
we find that the adjustment mentioned is a very valuable 
aid in securing the best results both as to completeness 
of the circulation and amount of blood drained. 

In anemic, tubercular, cancer of the stomach and ex- 
haustion cases, together with other conditions resulting 
in emaciation, the head end of the board should be 
raised to the height that seems suitable for the position of 
the upper part of the body when placed in the casket 
during the injection of the first bottle of fluid. When the 
first bottle of fluid has been injected, lower the head end 
of the board until the entire board is level, and leave 
it in that position until you have completed the injection, 
when you will again raise the end of the board until the 
position of the body is just as it will be in the casket. 

"When pneumonia and other non-emaciated bodies are 



ARTERIAL EMBALMING 211 

to be injected, with drainage, use the same procedure 
as is stated above for the emaciated bodies. 

In dropsical cases, raise the head end of the board only 
for the first bottle of the injection; then for the second 
bottle, lower the head end to about half of its first height, 
and set the foot end of the board on some object that will 
raise it five and six inches. In this way you will 
have a slight elevation at both ends of the body, and 
drainage can better be obtained from the center of the 
circulation. "When the operation is complete, lower the 
foot end again and raise the head end so that the body 
occupies the v proper position for the casket. 

These adjustments are practical methods of overcom- 
ing gravity handicaps in the distribution of the fluid, 
and of accelerating the amount of drainage obtainable 
by keeping the level of the drainage tube below the 
blood level in the body, thus accomplishing a universal 
distribution of fluid, and securing a greater quantity of 
undiluted blood from the vein. 

It is very important to remember when you are through 
injecting the body that you are to place the body in the 
exact position on the cooling board which you want it to 
have in the casket. After a little time the body will be- 
come more or less rigid due to the action of the preserva- 
tive fluid used, and will set in the position you have placed 
it which condition will be hard to change later. 

Selection of an Artery. — Great care should be taken 
in the selection of an artery. Never make a practice of 
using the same artery on all cases. Acquaint yourself 
with the location of them all, and on different occasions, as 



212 ARTERIAL EMBALMING 

different conditions arise, use the artery most likely to 
give the best results for the condition in hand. 

Convenience usually governs the operator as to the 
artery he is to use. If blood is to be removed it is 
best to raise one of the larger blood vessels, such as the 
carotid artery and the internal jugular vein, or the femor- 
al artery and femoral vein, or the axillary artery and 
axillary vein. If it is desired to draw the maximum 
amount of blood, the femoral artery and vein should be 
selected, as they are more dependent, and control more 
of the blood, when the body is placed on an incline. A 
drainage tube sufficiently long to reach above Poupart's 
ligament as far as the common iliac is all that is necessary 
as there are no valves intervening between the bifurcation 
of the common iliac and the right auricle. However if 
you can, extend the tube up through the ascending vena 
cava and eustachian valve into the right auricle. This 
will give you a chance to draw blood from the right auri- 
cle and is a much better procedure than tapping the right 
auricle with the trocar. 

If the body is already dressed and the hands or feet 
need to be re-injected, the radial or posterior tibial likely 
will be most convenient as their use will not necessitate 
the removal or cutting of the clothing. 

Of times there is but a single window to admit 
light and the operator should be so skilled as to be able 
to raise the arteries either on the right or left side without 
having to turn the cooling board. 

In emaciated subjects the linear and anatomical guides 
are always plain but in fleshy subjects this is not always 



ARTERIAL EMBALMING 213 

i 

the case. Look over the subject and see which artery will 
be the most convenient to raise. Usually in fleshy sub- 
jects the femoral is hard to raise as there is a great amount 
of fat in Scarpa's triangle making the artery lie very 
deep, but in these subjects the guide for the brachial is 
quite plain, a distinct groove being seen between the 
biceps and triceps muscles. 

In a short necked subject it is never advisable or con- 
venient to raise the carotid as there is not much room 
to work and the incision is very liable to show. Another 
artery will be found much more advantageous in these 
subjects. 

In accident cases the seat of injury will determine the 
artery to be raised, using the one through which you can 
give the body the greatest supply of fluid to all parts. 
Often it will be necessary to raise several arteries to com- 
plete the injection. 

There is no necessity for undue exposure in either 
sex, however it is hardly ever advisable to inject the 
femoral in the female, as some mischief-maker might 
without any real cause influence others in the community 
against your methods. 

When selecting the brachial and femoral arteries al- 
ways raise them at a place below the point where collateral 
circulation is given off or in other words raise them in 
the middle third. By so doing the fluid will reach, by 
means of collateral circulation, the tissues of the arm 
and leg below the point of injection. 

As far as the injection of fluid is concerned, one artery 
is just as good as another. All arteries are parts of the 



214 ARTERIAL EMBALMING 

same channel branches of the aorta. No valves exist in 
any part of their course. 

How to Raise an Artery. — With the scalpel make an in- 
cision an inch long in the average size arm, cutting 
through the skin and then through the fat. Reverse the 
blade and at each end of the wound cut forward and up- 
ward to make it clean. Take the grooved director and 
with the small end puncture the deep fascia, then reverse 
ends of the director and force the blunt end up the 
wound, underneath this deep fascia, one-fourth to one- 
half an inch longer than the wound. Now take the 
scalpel with the edge of the blade upward and split the 
fascia as far up as the needle extends and cut the tissue 
(fascia and fat) up to the skin, being careful not to cut 
the skin. Reverse the needle and cut the lower end of 
the wound the same way. This will give you an in- 
cision one inch long on top and one and one-half or two 
inches at the bottom of the wound, and none of the ves- 
sels will be injured. 

With the handle of the aneurism needle separate the 
tissues between the muscles, artery, vein and nerve, then 
use the hook end of the aneurism needle, pass it under 
the artery and raise it to the surface, passing the bone 
separator or the forceps with the closed end underneath. 
Remove the individual sheath surrounding the artery. 
Likewise raise the vein to the surface. 

If the artery and vein lie side by side and it is de- 
sired only to raise the artery, hook down between the two, 
away from the vein, sliding the hook forward and back- 
ward underneath the artery, then raise to the surface. 



ARTERIAL EMBALMING 215 

If the artery and vein lie side by side and it is de- 
sired to raise both, pass the hook around the vein first, 
as by hooking around the artery toward the vein the 
point of the hook will often rupture the vein. 

How to tell an Artery from a Vein or a Nerve. — Raise 
the suspected vessels to the surface, plaoing a bone 
separator underneath to form a bridge, which will cause 
the blood to recede on every side. If you are in doubt 
which is the artery, remove the individual sheath from 
each one. 

The nerve will appear as a glistening white cord, very 
solid to the touch and showing bands of nerve fibres 
which can be separated by the aneurism hook. It will 
not have any central opening. 

The vein will appear as a dark blue color and col- 
lapsible because of the fact that they have thinner walls 
than the arteries, lacking the middle circular layer of 
fibres. Veins have a central opening. As a rule the vein 
contains blood after death, which gives it the dark blue 
color but should it not contain blood, it resembles the 
artery very closely as to color. 

The vein contains valves which can be seen distinctly, 
if the blood be pushed the opposite way from which it 
runs in life. 

The artery is of a creamish white color and non-col- 
lapsible because of the fact that it has heavy walls and 
a middle circular layer of fibres. The arteries feel firm 
1 o the touch while the veins are soft and velvety. Arteries 
have a central opening and as a rule do not contain blood 



216 ARTERIAL EMBALMING 

after death. They likewise do not have valves. The ar- 
tery is usually more constant than the vein. 

Should all these not convince you, raise the one you 
think is the artery with the hook, pass the forceps under- 
neath, spread these and and pass the bone separator under 
for a bridge and with the scalpel incise the artery about 
one-fourth the way. Attach the arterial tube and if there 
is blood present, allow it to drain by lowering the arm. 
When it has ceased to flow, inject very gently and slow- 
ly. If you get a half -pint of fluid in the body, you may be 
assured of its being the artery. 

Another way to tell the artery from the vein is to 
roll them lightly between the fingers. If it feels like a 
thin rubber tube, and does not roll together in a little 
bundle, the supposition is that the vessel is an artery. 
This however is not certain, as phlebitis, or some other 
diseased condition of the veins may result in the thicken- 
ing of the walls of those vessels, to such an extent as to 
make it impossible to distinguish in this way between 
the artery and the vein. 

The anatomical and the linear guides for the arteries 
and veins, and their relation to the accompanying nerve, 
will help also to tell them, one from the other. 

How to Cut an Artery for Injection. — After the artery 
has been located it should be freed from the surrounding 
tissues and then raised to the surface. After it has been 
raised to the surface the bone separator which is to act 
as a support while cutting the artery, should be placed 
underneath the artery. 



ARTERIAL EMBALMING 217 

The artery may be cut in several ways as follows — a T 
shaped incision may be made. This is a very old method, 
one of the first to be used for this purpose. To make this 
kind of an incision in the artery, the scalpel is placed 
point down about one-fourth the distance from the edge 
of the artery, and then by forcibly bearing down on the 
scalpel cut the artery crosswise. Rotating the artery the 
cut will now be on the upper surface. Now from the 
middle of the crosswise cut, extend a longitudinal cut 
lengthwise of the artery, for almost one half inch. We 
have no comment to make on this kind of an incision, 
excepting to say that the method is old and obsolete, 
and no longer used, and that a much better method is 
now used. 

Another method suggested by some authors is the 
longitudinal incision. With the belly of the scalpel 
cut the artery lengthwise for a distance of a little less 
than one half inch. The disadvantage of this kind of a 
cut is that the operator does not know when he has cut 
to the center of the artery and no more than the center. 
If the cut has been made to a distance beyond the center, 
then the inside wall on the opposite side will be cut and 
if the wall is in the least diseased, the arterial tube when 
it is inserted may get between the walls which will mean 
that no fluid can be injected. 

Another method is to cut the artery crosswise, plac- 
ing the point of the knife on the artery about one fourth 
the distance from the edge of the artery, bearing down so 
that the point will come through to the bone separator 
which is beneath, then forcibly bearing down cut outward 



218 ARTERIAL EMBALMING 

with the belly of the knife. Now rotate the artery and 
the cut will be on the front of the artery. 

Another better method is the same as the above, but 
instead of cutting outward perpendicular to the artery, 
cut outward diagonally, then when the artery is rotated 
there will be a V — shaped cut. The point of the V 
should be made opposite the way the operator is to in- 
ject the fluid. With the aneurism hook, pick up the point 
of the V, which will mean that the hook will have to be 
inside of the artery, and using the hook as a guide in- 
sert the arterial tube. The only disadvantage of this 
method is that the tensil strength of the artery is to a 
certain extent weakened, but if the artery is not cut too 
deep, this is not a serious disadvantage. The advantage 
is that the operator is always certain that he is in the 
center of the artery, that if his knife is sharp, that he will 
always cut all three walls of the artery at once, and thus 
prevent a ruffling up of the inner wall of the artery 
should it be diseased. 

The Injection of Fluid. — One very important point to 
be taken into consideration when embalming, is the slow- 
ness with which the fluid should be injected. 

Upon this one thing will depend very largely the 
success you will have with the perfect circulation of the 
fluid and cosmetic effects. 

Some authorities on the art and science of embalming 
have made the claim that it makes no difference how 
rapidly a body is injected as the fluid is so widely distri- 
buted through so many branches of the artery that no 
harm can come from this source. This is very erroneous 
for when the fluid is forced rapidly through the arteries, 



ARTERIAL EMBALMING 219 

it also flows rapidly through the capillaries into the 
veins, thereby enlarging the quantity of fluid in those 
vessels and often forcing the blood into the exposed parts 
of the body, causing serious discolorations. 

The capillaries are sometimes ruptured by the rapid 
injection of fluid, " causing spots to appear on the face 
that would never have been there had the body been in- 
jected more slowly. 

A further reason for slow injection is that the disin- 
fecting fluid is given an opportunity to be absorbed by 
the tissues as* it passes into the capillaries and not be 
forced through those little vessels into the veins, as it is 
by the absorption of the fluid that the body is disin- 
fected. This is especially true when the drainage tube is 
being used as the fluid, seeking the course of least re- 
sistance, passes through the artery, into the capillaries, 
through those vessels to the veins and out through the 
drainage tube. 

As it takes but little blood to color a large quantity of 
embalming fluid, many embalmers are led to believe that 
they are removing large quantities of blood, while in 
reality perhaps one-half of the colored liquid which flows 
from their drainage tube is the fluid which is being in- 
jected. Many failures have resulted from this error. 

Fluid should always be injected into the body very 
slowly, and the more slowly it is injected the more per- 
fect will be the cosmetic effect. 

If necessary make a second injection. An embalmer 
who makes the proper charge for his services as a pro- 
fessional can afford to make two injections if necessary. 



220 ARTERIAL EMBALMING 

He can let it be known that he will not be content with 
anything but perfect work, and patrons will not only 
cheerfully pay for it, but will have a better opinion of 
his professional standing. Thorough drainage and slow 
injection are the best safeguards against discoloration. 

Dr. Erdman before the Minnesota association suggests 
that the amount of fluid that fills the arteries is not enough 
to percolate through the capillaries and into the tissues, 
and saturate all the parts of the body. He favors the 
gravity injection by merely allowing the fluid to flow 
naturally into the arteries from an elevated vessel, and 
would use no force or pressure in injection. Ideal em- 
balming would be a series of gravity injections at in- 
tervals of several hours. While the gravity injection 
such as the doctor describes will undoubtedly be a sure 
method of getting a perfect circulation, and while it is 
the process generally pursued in morgue work where the 
apparatus is convenient, it is in the majority of cases in 
the home impractical. 

All bodies to be shipped must be thoroughly arterially 
embalmed, that is, to have introduced into the arterial sys- 
tem sufficient amount of disinfecting fluid to thoroughly 
sterilize every particle of matter in the dead body. This 
can only be done by introducing into the arteries an 
approved disinfecting fluid.* 



*The quantity to be injected of course varies, but a fair 
estimate would be that the quantity should be three-fourths of 
the capacity of the blood vessels of the body. This would require 
approximately one and one-eighth gallons of fluid to every 150 
pounds of tissue. The latest transportation rules demand the 
injection of an amount of fluid equal to 10% of the body weight 
into the arteries. 



ARTERIAL EMBALMING 221 

Approved Disinfectants. — This is construed by most 
states to mean a fluid which is sufficient in strength to 
kill all the germs on the surface of the body or on the 
interior. An approved disinfectant for the external sur- 
face of a dead body is a solution of 1 :1000 bichloride 
of mercury. An embalming fluid which has the official 
approval should contain 5% formaldehyde. 

Embalming Fluids. — At the present time only a few 
states have placed restrictions on fluids. These restric- 
tions are that they contain neither mercury, arsenic, 
antimony or any of their compounds. These poisons 
when used to inject a body make it almost impossible 
to detect from a chemical analysis whether death was 
caused by a poison or the poison was from the embalming 
fluid. Iowa recommends a fluid the formula consist- 
ing of formaldehyde, glycerine, borax, boracic acid, salt 
petre and water. 

Wrapping a Body in Cotton. — In certain diseases, 
when a body is to be shipped, the law compels the em- 
balmer to wrap the body in cotton. This may be the or- 
dinary cotton purchased from a dry goods store. The 
cotton should be cut in strips at least one to one and one- 
half feet longer than the body. Two layers are laid side 
by side upon a sheet, the body then placed thereon and 
the whole wrapped about the body will envelope the body 
in a satisfactory manner. This means that the entire 
body, is to be enveloped, so that the face head or feet 
will not be exposed, and the wrapping should never be 
removed. Absorbent cotton may be used for this work, 



222 ARTERIAL EMBALMING 

but it is more expensive and not as good as dry cotton 
for this purpose. 

*The Charge of Embalming. — This subject is one that 
has long been forcing itself upon the thought and at- 
tention of progressive undertakers, principally because 
of the many abuses and misunderstandings that have 
grown out of the manner in which members of the pro- 
fession regard the value of their services and the care- 
less and indifferent systems used in conducting the busi- 
ness side of our work. 

In order to succeed in a chosen calling one must first 
have a liking and a natural adaptation for the work ; sec- 
ond, he must prepare himself by obtaining a thorough 
working knowledge of the profession or business he ex- 
pects to follow. He must educate himself for the work. 
This is fundamental and has been proven many times with 
the successes in every profession. It is fair to presume 
then that the great majority of men entering this profes- 
sion have considered the probabilities of success and have 
met the requirements needed to qualify them to follow 
this calling and to receive the support of any who through 
necessity need their services. 

Without going into the non-essentials showing the 
rights of individuals holding a license as an embalmer to 
practice, we may naturally come to the next question in 
this connection, the value of his services and how they 
should be charged for. Charge what your work is worth, 



*Extracts from a paper written by F. W. Alexander, 
Conrad, Iowa. 



ARTERIAL EMBALMING 223 

and do not conceal the amount in the price made on the 
casket or any other part of the funeral expenses. Make 
it a specific charge in every instance for there is a good 
and sufficient reason why you should. 

An explanation of these reasons may be summed up 
as follows : the conscientious effort in qualifying yourself 
to meet the needs of your calling and the requirements of 
the state, the cost of your training and education in time 
and money, the years spent in the hard school of practi- 
cal experience and self development. 

Next your business equipment and investment, the 
care of the case on which you are called, its peculiar re- 
quirements and how it taxes your skill in doing the 
work, the risk from infection, the distance you must tra- 
vel and the expense of the trip. All of these considerations 
enter into the cost and should be the basis on which to 
formulate a charge for the work. 

Just as the well equipped surgeon of wide experience 
and training skillfully performs operations relieving 
suffering, saving and prolonging life, naturally allows the 
difficulties of the case and the distinctive personal ser- 
vice rendered to govern him in the amount of the fee, 
so in a very similar sense the services of the embalmer 
should hold a certain ratio of value to the conditions 
under which he works and the ability he employs in its 
performance. Therefore let me again urge that you 
make it a specific charge showing it a distinctive per- 
sonal service. 

In the matter of the value of personal services the 
question is often raised; "Which is the more important 



224 ARTERIAL EMBALMING 

part of the work in our profession, directing and manag- 
ing the funeral or the embalming and care of the body. ' ' 
In answer to this let me say that the care and the em- 
balming of the body is first importance because the law 
says so, because the education of the embalmer is para- 
mount to other considerations and so regarded by the 
national association, because sanitary science demands 
it. because without a body properly embalmed and pre- 
pared for burial the funeral is a failure from whatever 
standpoint you wish to judge it. 

A director may bungle the arrangements and at the 
most it is but a matter of annoyance to the family. How- 
ever, let him fail to properly fit and prepare the body so 
that the relatives can see restored to them the face of 
their beloved one, beautified in the last long sleep of 
death, and they will never forgive him. They secured 
his services first as an embalmer and incidentally as a 
director of the funeral, naturally, therefore, the greater 
importance of his work centers around his services to 
the family in that capacity. Now in all candor, why 
should he not make a specific charge for his work? He 
is rendering the greater service in caring for the body, 
it should be the first item charged for on the funeral bill. 



CHAPTER XVI. 

THE ANATOMICAL AND LINEAR GUIDES FOR 
SPECIAL ARTERIES. 

How to Locate and Inject the Carotid Artery. — The 

carotid artery, is not used much, by the average em- 
balmer for several reasons. It is usually a hard artery 
to raise, partly because the average embalmer does not 
know the anatomy of the neck. In subjects having short 
and very fleshy necks it is not advisable to use the caro- 
tid, however in subjects where the neck is long and not 
fat it is with some a favorite. It is always essential to 
know how to raise and inject the carotid for in accident 
cases, where the arteries of the lower part of the neck 
and thorax are ruptured it becomes necessary to raise 
rvd inject the carotids to get the fluid into the tissues of 
the face and brain. In cases of suicide where the arter- 
ies of the neck have been cut it is necessary to know 
where the arteries and veins lie so that they may be tied 
off. Often the body is so badly mutilated that it is im- 
possible to raise any other artery excepting the carotid. 
Every practitioner should know how to raise and inject 
this artery, even though some other artery is the one 
generally used. 

225 



226 



THE ANATOMICAL AND LINEAR GUIDES. 




FiG. 46 — The arteries of the neck. (Gray) 

Linear Guide. — By a linear guide is meant that an 
imaginary line is drawn from a point to a point the 
same direction the artery runs so that by mentally im- 
magining this line one can be safe to cut on the line and 
be sure that the desired artery will be reached. 

The linear guide for the carotid is represented by 
a line drawn from the sterno-clavicular junction to a 
point between the angle of the jaw and the lobe of the 
ear. (Mastoid process). 

As the body lies on the cooling-board place one finger 



THE ANATOMICAL AND LINEAR GUIDES. 227 

on the sterno-clavicular junction and the other at a point 
between the angle of the jaw and the lobe of the ear, 
and by cutting on this imaginary line, the artery will be 
reached, providing the artery is normal and if the em- 
balmer is thoroughly acquainted with the anatomy about 
the artery, as is summed up in the anatomical guide. 

Anatomical Guide. — By the anatomical guide is meant 
the relation which the artery bears to the surrounding 
tissues. 

The anatomical guide for the carotid artery is that 
the artery lies between the sterno-mastoid muscle to the 
outside, and the muscles surrounding the trachea (wind 
pipe) and the esophagus, to the inside. In the middle 
third or sometimes between the middle and upper third 
the omohyoid muscle crosses over the artery. 

Perpendicular Incision. — The artery is divided for 
the sake of description into thirds. By making an in- 
cision on the linear guide in any one of the thirds the 
tissues that must be passed through are the following: — 
skin, platysma muscle, superficial fascia, deep fascia, com- 
mon sheath, and the individual sheath. 

The platysma muscle is a broad tissue paper like 
muscle, placed immediately beneath the skin and a part 
of the superficial fascia, in the cervicle or neck region. 
It arises by thin fibrous bands from the fascia covering 
the pectoral and deltoid muscles on the thoracic wall, 
and passes upward over the clavicle and inserts the 
lower jaw. This muscle is so delicate and the fibers so 
finely divided that it is hardly perceptible. When the 
skin is cut, the platysma muscle will as a rule be cut 



228 THE ANATOMICAL AND LINEAR GUIDES. 

too, and because of its thinness it will rarely be seen or 
does it form any hindrance to the raising of the artery. 
It is only mentioned here because it forms part of one 
of the questions so often asked by the State Board in 
their examination : ' ' What tissues would you pass through 
in raising the carotid artery?" 

Having cut through the skin and platysma muscle, the 
superficial fascia is next seen. In this part of the bobly 
it consists of but a single layer and very thin. 

The deep fascia lies next and constitutes a complete 
investment of the neck. When this is torn or cut through 
the sternomastoid muscle comes into view. 

The sternomastoid, is a large, thick muscle, which 
passes obliquely across the side of the neck, being inclosed 
between two layers of deep fascia. It has its origin at 
the sternum and clavicle and attaches to the mastoid 
process of the temporal bone. By making the perpen- 
dicular incision in the lower third, in as much as the 
muscle slightly coyers the artery, it can either be cut 
or pushed to the outside of the incision. It is best to 
push the muscle to the outside with the thumb, and with 
the handle of the scalpel, work down deep through the 
areolar tissue. The operator will now arrive at the com- 
mon sheath, or that part of the deep fascia surrounding 
the artery, vein and nerve. The common sheath will be 
very tough and a slit must first be cut, then it can be torn 
the length of the incision. 

The artery will now be seen lying next to the wind pipe 
and the internal jugular vein to the outside. In the lower 
third the artery will be about one-half inch deep, while 



THE ANATOMICAL AND LINEAR GUIDES. 229 

in the upper third it will be about one to two inches deep, 
owing to the amount of fat in this region. In the upper 
third, the omohyoid muscle crosses over the artery, which 
must be either pushed aside or cut in two. 

It is always advisable, to raise this artery in the low- 
er third, as it is less apt to show in that third. 

Loosen the artery well from the surrounding tissues 
with the aneurism hook, raise to the surface and place 
a bone separator beneath the artery. 

Now remove the individual sheath, incise the artery 
and insert the arterial tube. 

If it is desired to raise the internal jugular vein for 
the withdrawal of blood, it is best not to open up the 
common sheath, but to raise the artery and the vein both 
at the same time. Having raised them to the surface 
they can then be separated by the removal of the common 
sheath and dropping it back into the incision. 

If it is desired only to raise the carotid, the hook 
should always be inserted between the artery and the 
vein, and directed toward the trachea. If it is directed 
around the artery in the other direction there is danger 
of rupturing the vein, and thus getting a bloody incision. 

The Circular Incision. — In the circular incision as 
much of the skin as can be, is pushed above the clavical 
bone from off the chest wall. The cut is then made from 
one sterno-clavicular junction to the other following the 
supra-sternal notch. This method was devised for the 
use of the "Y" shaped tube, where both sides of the 
face could be injected at the same time. One precaution 
however should be noted, which is, that care should be 



230 THE ANATOMICAL AND LINEAR GUIDES. 

taken that not more than the skin, be incised with the 
first cut. Just below the incision will be noticed a little 
branch vein which runs into the arch connecting the two 
external jugular veins. If the first cut is too deep* this 
branch will be cut, and a flow of blood will result. How- 
ever by cutting carefully this little branch can be noticed, 
tied off in two places and cut in between, and thus cause 
no further trouble. Remembering the linear guide, the 
artery can be reached by going down at either end of the 
incision. The tissues to go through will be the same as 
for the perpendicular incision, and the method of raising 
the artery will be the same, only, in the circular incision 
usually both carotids are raised, so as to inject both sides 
of the face at the same time. 

The only advantages derived from the circular in- 
cision is that one can by the use of the "Y" shaped tube 
inject both sides of the face at the same time and get 
an equal distribution of fluid, and that after the injection 
is over, and the incision sewed up, the skin can be pulled 
back in place, making the incision appear much below the 
clavical, and where it is less liable to show than in the 
perpendicular incision. 

For embalming female subjects, if the carotid is chos- 
en as the artery to use, it will be best to use the circular 
incision. However for ordinary embalming it will perhaps 
be best to choose some other artery, which will be less 
apt to show, and not so deep. 

We should be so skilled as to never make a mistake, 
but the best sometimes do make mistakes. If in raising 
another artery, a mistake should occur, the operator 



THE ANATOMICAL AND LINEAR GUIDES. 231 

can raise either above or below the original cut, but with 
the carotid, the only advisable incision to make is in the 
lower third, and if a mistake is made the last chance is 
lost. For this reason then a great amount of care should 
be taken. 

In injecting the body from the carotid, the arterial 
tube should be inserted first toward the heart, and after 
the body has received a sufficient amount of fluid, if it 
is noticed that the side of the face from which you are 
injecting has not received a supply of fluid, then reverse 
the tube and inject a few bulbs of fluid upward. 

Relation of Artery, Vein and Nerve. — The common 
carotid artery lies in relation to the internal jugular 
vein and the pneumogastric nerve. The artery lies to the 
inside next to the muscles surrounding the trachea (wind- 
pipe). The internal jugular artery lies to the outside of 
the artery. Just back of the common carotid artery 
and the internal jugular vein and between the two lies 
the pneumogastric (vagus) nerve. These all as a rule 
lie in the same common sheath of deep fascia. 

How to Locate and Inject the Axillary Artery. — The 

axillary in recent years has come to be a much used 
artery. It not quite as large as the common carotid, but 
as a rule large enough to admit the large size arterial 
tube. It has become a favorite with many because it 
is quite easy to locate and to raise, and because of its 
proximity to the axillary vein, a vein which is large 
enough to admit a drainage tube for the withdrawal of 
blood. Again the axillary artery is in a secluded place, 
being as it is in the axillary space (arm pit). The artery 



232 



THE ANATOMICAL AND LINEAR GUIDES. 



does not lie very deep, and is not covered by any muscles 
as you operate, there being practically nothing to hin- 
der the progress of the operation. 




FlG. 47 — The axillary and its branches. (Gray) 

Then after the operation is completed and the arm 
placed back in normal position, the casual observer is not 
liable to see the incision, even though the body be only 
partially dressed. 

Linear Guide. — A line drawn through the center of 
the axillary space (arm pit), at the anterior border of 
the hair line. 

The Axillary Space. — When the arm is maintained in 
a horizontal plane, the axilla has the shape of a three- 
sided pyramid, the apex of which lies above, below the 



THE ANATOMICAL AND LINEAR GUIDES. 233~ 

clavicle, and the base of which corresponds to the low- 
er wall, covered only by skin and fascia. 

The axilla is filled with blood vessels, lymph ves- 
sels, lymph glands, nerves, and masses of fat. 

To Raise the Artery. — Make an incision on the linear 
guide. After the skin is passed through there is a large 
quantity of fascia, lymph glands, and lymph vessels, 
Avhich must be carefully dissected through, and at the 
same time the axillary vein will be discovered. This 
vein, for the present, should not be loosened from the 
surrounding tissues. Dissect down to the upper side of 
the vein, and the common sheath of fascia surrounding 
the artery and nerves will be seen. By carefully tearing 
this the length of the incision, the brachial plexus of 
nerves now is exposed. Now by gently pushing the 
nerves apart with the handle of the scalpel, the artery 
will be seen. With a hook loosen the artery from the 
r :urrounding tissues and raise to the surface. 

If it is desired to draw blood, now proceed to raise 
the vein to the surface. Open the' vein and insert a drain- 
age tube, which should be long enough to reach through 
the entire length of the axillary and subclavian veins, 
because they have valves- along their entire course nearly 
to the bifurcation of the innominate. 

Inject a few ounces of fluid toward the hand as the 
axillary is above the point of collateral circulation. Then 
reverse the tube and inject toward the heart, until a 
sufficient amount of fluid has been injected. 

Relation of Artery, Vein and Nerve. — The vein is 
quite superficial, just below it and to the upper part of 



234 THE ANATOMICAL AND LINEAR GUIDES. 

the incision is the brachial plexus of nerves, which sur- 
rounds the artery. 

How to Locate, Raise, and Inject the Brachial Ar- 
tery. — The brachial artery is located in the upper arm 
and extends from the inferior margin of the muscle 
pectoralis major, or from the shoulder to the elbow. It 
is one of the most popular arteries known to the em- 
balmer, and is now used, perhaps, more than all others 
combined. 

The anatomy of this vessel is simple, yet, when we 
take into consideration all the numerous anomalies or 
irregularities that surround its use to us as embalmers, 
we feel the necessity of making the description very tho- 
rough and complete, in order to raise it under all the 
various difficulties that attend its use. 

The brachial artery has its several branches, the most 
prominent of which are the artery profunda brachii (su- 
perior profunda artery) and the artery collateralis ulnar- 
is superior (inferior profunda artery) and the artery 
collateralis inferior (anastomotica magna artery). 

For the sake of a more correct description we divide 
the artery into thirds, viz: the upper, middle and lower 
thirds. The upper third begins at the extreme upper 
part of the arm and extends one third of the way to the 
elbow, the middle and lower thirds occupy the remainder 
of the artery. In the upper third we have the superior 
and inferior profunda arteries coming off; their position 
is not always the same, and in the extreme lower third 
the anastomotica magna artery. These arteries con- 
tinue down the outer and inner arm and anastomose with 



THE ANATOMICAL AND LINEAR GUIDES. 



235 



the recurrent radial and ulnar arteries, thus furnish- 
ing collateral circulation. Thus if the fluid is injected in 
the middle third, toward the heart, these branches that 
come off the brachial in the upper third will convey the 
fluid down the arm, filling the branches below the point 
of injection, which supply the forearm and the hand. 
The brachial artery is one continuous vessel, the entire 
length of the upper arm, and varies in 
size according to the size of the per- 
son and the development of the arm. 
It is accompanied by the venae comites 
or deep brachial veins, the one to the 
inner side of the artery about one- 
third to one-half the size of the ar- 
tery, the other about one-half its size 
lies directly underneath. All are en- 
cased in the same common sheath of 
deep fascia that surrounds and holds 
them together. Great care, then, 
should be taken to separate the 
artery from these veins before cut- 
ting the artery for injection. 

The artery lies along the inner and 
under border of the large muscle on 
top of the arm known as the biceps. 
The biceps is the muscle used when 
lifting a weight. To those whose oc- 
cupation is to exercise the muscular 
tissue of the body liberally, this 
muscle becomes quite large, and generally the artery 
is proportionally large. 




Fig. 48 -The brachial 
artery. (Gray) 



236 THE ANATOMICAL AND LINEAR GUIDE^. 

Linear Guide. — The course of the brachial artery may 
be marked out by drawing a line from the middle of the 
axillary space (arm pit) to the center of the elbow, pro- 
vided the palm of the hand be turned upward. This 
line will be immediately over the artery, which will be 
found by cutting through the skin at any point on the 
line, and dissecting through the subcutaneous tissue to- 
ward the center of the arm. 

, The Anatomical Guide. — In the upper third the artery 
lies between the biceps and coracobrachialis muscles which 
lie above the artery, and the triceps muscle which lies 
below the artery. In the upper third the nerve lies close 
to the muscle, the artery below and to the inner side to- 
ward the body, and the vein a little farther to the inside. 

In the middle third the artery lies between the biceps 
which lies above the artery, and the triceps muscle which 
lies below the artery. In the middle third the artery 
will lie beneath the nerve. 

In the lower third the artery lies between the biceps 
which lies above the artery, and the triceps which lies 
below the artery. In the lower third the artery lies next 
to the muscle and the nerve to the inner side next to the 
body, and the vein still farther to the inner side. 

How to Raise the Artery. — First trace the inner bor- 
der of the biceps muscle, feel for the median nerve, which 
will always be present. The artery in the middle and low- 
er thirds will follow the border of the muscle. The palm 
of the hand should always be turned upward, and the 
linear guide, as stated above, will indicate the exact 
position of the artery. Make an incision through the skin, 



THE ANATOMICAL AND LINEAR GUIDES. 237 

on the linear guide, pushing the fatty subcutaneous tis^ 
sue to one side, if there be any, and with the handle of 
the scalpel, work through the superficial fascia. Reverse 
the blade, and at each end of the incision, cut forward 
and upward to make it clean. Now with the scalpel 
cautiously cut through the deep fascia, and remove this 
from the vessels below. This will expose to view the 
median nerve, and with the handle of the scalpel, separ- 
ate the tissue between the artery and the muscle, and 
between the artery and the nerve. Having thus freed 
the artery, use the hook end of the aneurism needle and 
pass it under the artery toward the muscle, and raise 
the artery to the surface. Pass the bone separator or the 
forceps with the closed end, underneath, remove the 
sheath surrounding the artery and the deep brachial 
veins. The natural position will be, the artery on top, 
the larger deep brachial vein to the inner side and the 
smaller one underneath. It is very necessary to remove 
these deep brachial veins, for the reason that if they are 
not, in cutting the artery for injection, they will be cut 
also, resulting in a flow of venous blood into the incision. 

How to Locate, Raise and Inject the Radial Artery. — 

The radial artery is one of the branches of the brachial 
artery, and extends from about one half inch below the 
bend of the elbow, along the valley of the forearm, to 
the thumb part of the hand. It is divided into thirds, viz : 
the upper, middle and lower thirds. It is accompanied in 
close relation by the radial veins, but in no way do they 
\nterfere with the operation of raising the vessel. The 
value of this artery is in the embalming of ladies, where 



238 THE ANATOMICAL AND LINEAR GUIDES. 

the body has been dressed and the sleeve cannot be re- 
moved to use the brachial artery without material in- 
convenience and annoyance. It is especially desirable to 
those who are just beginning to use the arteries. 
The radial artery is somewhat smaller than the ulnar, 
but, on account of the depth of the latter and incon- 
venience of raising, the radial artery is the one artery in 
the forearm which is generally used. It is an excellent 
vessel to employ in cases where the friends are opposed 
to embalming because of the mutilation of the body, as 
they choose to call it. Some object to the use of this ar- 
tery on account of the fact that the mutilation is not 
easily hidden. The wound can be easily covered by simply 
pulling the sleeve down to its normal place. The incision 
necessary to be made is so small and it can be closed 
so neatly, that no objection on the part of the relatives 
need be apprehended. 

Before the advent of formaldehyde fluids the radial 
artery offered more advantages to the embalmer than 
any other artery used for injecting. But at the present 
time almost all embalming fluids contain large quantities 
of formaldehyde, and when injected into this artery, 
which is very small, it is liable to constrict the vessel to 
such an extent as to sometimes make it difficult to in- 
ject the fluid. 

Moreover, since both the radial and the ulnar arter- 
ies have many branches, a large quantity of fluid is li- 
able to accumulate in the forearm, hardening it more 
than is necessary and giving the hand an undesirable 
color. 



THE ANATOMICAL. AND LINEAR GUIDES. 239 

The radial artery is very superficially located, and 
can be secured without the possibility of error and with 
very little mutilation. The expert will, of course, choose 
that vessel which he believes will at the time and under 
the circumstances best serve his purpose. 

The Linear Guide. — Is a line drawn from the center 
of the bend of the elbow to the center of the ball of the 
thumb. 

The anatomical guide for the radial artery (in the 
wrist, where it should be raised) is the brachio-radialis 
muscle on the outside of the artery and the flexor carpi 
radialis muscle on the inside of the artery. 

When about to raise this vessel, the embalmer should 
hold the arm at right angles with the body, with the 
palm up, and holding the hand of the body, with the 
hand, draw the arm tight. In most bodies this will show 
plainly the tendons of the muscles between which the 
vessel lies, thus affording an excellent guide for the in- 
cision. The arm should never be grasped and the tissues 
drawn out of their normal position, as that is very mis- 
leading. The vessel should be raised at a point about 
three inches above the wrist joint (the space where you 
would feel the pulse beat in life). The operator making 
an incision through the skin, superficial fascia, and fat, 
about one-half inch in length, will plainly see the artery 
lying in its sheath between the two tendons of the mus- 
cles. The cut should now be opened carefully, by placing 
the fingers on either side of it, and the fascia dissected 
from the artery, when it can easily be raised with the 
aneurism hook. There is no other vessel at this point 



240 



THE ANATOMICAL AND LINEAR GUIDES. 




Fig. 49 — The radial and 
ulnar arteries. (Gray) 



that can be mistaken for the radial 
artery. Its two venae comites, or 
accompanying veins, are usually 
attached to the artery and need 
not be removed, as they are *very 
small and can give the embalmer 
no trouble. 

How to Locate, Raise and Inject 
the Ulnar Artery. — The ulnar is 
the larger branch of the brachial 
artery. It crosses obliquely the in- 
ner side of the forearm, to the be- 
ginning of its lower half, it then 
runs along the ulnar border to 
the wrist, crosses the annular liga- 
ment on the radial side of the pisi- 
form bone (wrist bone), and im- 
mediately be3^ond this bone into 
two branches, the superficial and 
deep palmar arch. In its upper 
half it is deeply seated, being 
covered by all the surface muscles. 
It is crossed by the median nerve, 
which lies to the inner side for 
about an inch. In the lower half 
of the forearm the artery runs 
more superficially, and is covered 
only by the skin and superficial 
and deep fascia, but at that, the 
ulnar lies a little deeper in the 
wrist than the radial. The ulnar 



THE ANATOMICAL AND LINEAR GUIDES. 241 

nerve lies to the inner "side in the lower half and the 
ulnar artery is accompanied by two ulnar veins, one on 
either side, called the venae comites. 

The Linear Guide. — Is a line drawn from the center 
of the bend of the elbow, to the inside of the pisiform 
bone in the wrist. 

The Anatomical Guide. — The artery lies in a groove 
in the wrist, made by the flexor carpi ulnaris muscle on 
the outside, and the flexor digitorum sublimis on the 
inside. 

To raise the ulnar artery, locate the valley in the 
lower third about one to two inches above the pisiform 
bone. Make an incision about an inch in length, cutting 
first the skin, superficial fascia, layer of fat, which will 
vary in thickness. The deep fascia is now reached, which 
should be split by means of the fascia needle and bistoury. 
Then separate with the handle of the knife or bone sep- 
arator, the artery from its connective tissue on either 
side. Then with the hook raise it to the surface, and 
place the bone separator beneath, remove the hook, and 
tear off the individual sheath. 

The two ulnar veins will be separated from the artery 
by taking away the individual sheath, which should be 
allowed to drop back into the incision. Proceed now to 
open and inject the artery the same as you would the 
radial or the brachial. While this artery may seem just 
a little more difficult to raise, still at times it has its place 
in arterial embalming. 

How to Locate, Raise and Inject the Femoral Artery. — 

The femoral artery is usually objected to, because, sit- 



242 THE ANATOMICAL AND LINEAR GUIDES. 

uated as it is, it requires an undue exposure of the limb, 
especially in ladies. For this reason, then, the femoral 
artery should never be raised in the female, excepting in 
accidental case when it is impossible to raise any other 
artery. In the male, however, the femoral with many is 
a favorite. The artery should be raised either in the upper 
or the middle thirds, but preferably in the former, as by 
raising at this point the artery is not very deep in the 
tissues as it will be further down, and at the same time 
one is able to get collateral circulation to the lower leg 
and foot by means of the deep femoral and the recurrent, 
anterior and posterior tibials. 

It is believed quite commonly, that by the injection 
of the femoral artery, there is a great danger of flushing 
the face. This belief is erroneous. Flushing of the face 
will result from the injection of any artery if it is full 
of blood and if it is found that the femoral artery con- 
tains blood, and likewise any other artery, this blood 
should be removed before injection takes place, and what 
little then remains, will not discolor the face, since h 
will be greatly diluted. 

The internal long saphenous vein is mistaken fre- 
quently for the femoral artery. It is a superficial vein 
and is usually found empty after death. It lies a short 
distance to the inner side of the femoral artery in Scarpa 's 
triangle. This vein is taken up frequently, not only by 
the younger members of the profession, but by the older 
as well, when the guides are not followed closely, and 
when this mistake does occur, and fluid is injected 
through it, flushing of the face results. 



THE ANATOMICAL AND LINEAR GUIDES. 



243 



Next to the common carotid artery the femoral artery 
is the largest branch artery used in embalming. The 
femoral artery commences immediately behind Poupart's 
ligament and is a continuation of the external iliac artery. 

It passes down the forepart and 
inner side of the thigh, terminates at 
the opening in the adductor magnus, 
' at the junction of the middle with 
the lower third of the thigh, where it 
becomes the popliteal artery. In 
the upper third the artery is con- 
tained in a triangular space called 
Scarpa's triangle and in the middle 
third of the thigh it is contained in 
an aponeurotic canal called Hunter's 
canal. 

At a point about one and one-half 
to two inches below Poupart's liga- 
ment, the femoral artery gives off a 
branch to the outer and under side, 
known as the deep femoral artery, or 
the profunda femoris, which courses 
the thigh downward, and connects 
with branches coming off the pop- 
liteal and the anterior tibial arteries, thus forming the 
collateral circulation to the lower leg and foot. 

As the femoral artery leaves the body, it is accom- 
panied by the femoral vein, which for two inches down, 
lies along side the femoral artery to the inner and under 
side. At about this juncture, however, it passes under 




Fig. 50— The femoral 
artery. (Gray) 



244 THE ANATOMICAL AND LINEAR GUIDES 

neath the artery and continues its course in that position 
until it passes below where we have occasion to use the 
artery. 

The femoral artery can be used all the way from where 
it leaves the body at Poupart's ligament until it reaches 
Hunter's canal. At Poupart's ligament the artery is very 
superficial, being covered only by the skin, superficial 
fascia and superficial lymphatic glands, but it gets deeper 
further down, being covered not only by the above named 
Tissues, but also by muscles, making it very difficult to 
raise m the middle and lower thirds of the thigh. About 
five to seven inches below Poupart's ligament the artery 
passes under the adductor magnus muscle, and enters 
what is known as Hunter's canal. Because this artery 
does get deeper as it courses down the thigh, it is gen- 
erally raised in the upper third. 

A knowledge of the anatomy of the vessels of the 
thigh and leg will be of value in treating accidents when 
this member is injured. 

Scarpa's triangle is a triangular space, the apex of 
which is directed downward, and the sides formed ex- 
ternally by the sartorius muscle ; internally by the inner 
border of the adductor longus muscle, and above by 
Poupart's ligament. The floor of the space is formed 
from without inward by the ilio-psoas pectineus and the 
adductor longus muscles. The space is divided into two 
nearly equal divisions by the femoral vessels, which ex- 
tend from the middle of its base to its apex, the artery 
giving off in this situation the superficial and profunda 
branches, and the vein receiving the deep femoral and the 






THE ANATOMICAL AND LINEAR GUIDES 245 

internal saphenous veins. Besides the vessels and nerves 
this space contains some fat and lymphatics. 

Hunter's canal is the aponeurotic space in the middle 
third of the thigh, extending from the apex of Scarpa's 
triangle to the femoral opening in the adductor magnus 
muscle. Hunter's canal contains the femoral artery and 
vein inclosed in their own sheath of areolar tissue, the 
vein being behind and on the outer side of the artery, 
and the long saphenous nerve lying at first on the outer 
side and then in front of the vessels. 

Linear Guide. — The guide for the femoral artery is 
represented by a line drawn from the center of Poupart's 
ligament to the inner side of the knee joint. 

Poupart 's ligament extends from the crest of the ileum 
bone to the top of the pubic bone. To determine the 
center of Poupart's ligament for the right leg, get on 
the right side of the body and with the left hand, place 
the second finger on the top of the pubic bone and the 
thumb on the crest of the ileum bone, then let the index 
finger drop down between the two which will represent 
the commencement of the femoral artery. 

Anatomical Guide. — The artery runs through the cen- 
ter of Scarpa's triangle from the center of its base to 
its apex. In the middle third of the thigh the artery 
passes beneath the vastus medialis muscle and enters 
Hunter's canal. 

Relation of the Artery, Vein and Nerve. — The fem- 
oral vein at Poupart 's ligament lies close to the inner side 
of the artery, separated from it by a thin fibrous partition ; 



246 THE ANATOMICAL AND LINEAR GUIDES 

but two inches down the vein runs behind the artery and 
then to its outer side. 

There is no nerve in relation to the artery in the upper 
third, the anterior crural nerve lies about half an inch 
to the outer side of the femoral artery, being separated 
from the artery by the ilio-psoas muscle. In the middle 
third of the thigh the internal saphenous nerve is sit- 
uated on the outer side of the artery, but not usually 
in the same sheath with the artery. 

To raise the femoral artery in its proper place, is to 
measure down from Poupart's ligament from one and 
one-half to two inches in the linear guide, and there be- 
gin the incision, making it tWo inches or less in length. 
This will bring the incision below the point where the 
collateral branches are given off. Cut through the skin, 
then the fat, which will vary in thickness with the sub- 
ject. Underneath the fat are several layers of deep fascia, 
which must be split the length of the incision. 

The femoral artery will then be seen, and underneath 
it will be the femoral vein. Both will be in the same 
common sheath of fascia, which may be removed with a 
hook by gently tearing the sheath loose over the artery. 
When the artery has been loosened the length of the 
incision, raise it to the surface, placing a bone separator 
underneath for a bridge. 

If it is desired to remove the blood, the femoral vein 
should then be raised. 



CHAPTER XVII. 

CAVITY EMBALMING. 

Cavity Embalming. — In shipping a body, cavity em- 
balming must always be resorted to and consists of in- 
troducing a trocar into the abdominal and thoracic cavi- 
ties and injecting sufficient fluid over the contents of 
these cavities to thoroughly preserve them. 

The scientific work in the embalming of to-day is 
being done on the arteries, but cavity embalming should 
still hold an important place with those embalmers who 
desire to get the best results. Although the arteries have 
been injected, yet we find that sometimes the fluid does 
not reach the cavities. Any cavity may contain gas or 
material for decomposition, such as blood, pus, lymph, 
or as in perforation of the intestines, feces in the ab- 
dominal cavity. Besides these we always have the bac- 
teria of decomposition, called saprophytes, which have 
thoroughly invaded the organs and tissues of the body 
as soon as sixteen hours after death. Then, if for any 
reason the fluid has not reached a certain part, fermenta- 
tion, and putrefaction will immediately set in. 

The Cerebral Cavity. — Gases may be generated in the 
cerebral cavity soon after death, especially in drowned 

247 



248 CAVITY EMBALMING 

cases, where the gas forming bacteria, the aerogenes cap- 
sulati, are distributed all over the body. These bacteria 
work much more rapidly in fresh or shallow water, or 
in the summer when the water is warm, than in the 
winter when the water is cold, or the body is in salt 
water. The gases may penetrate every tissue in the body, 
particularly the tissues about the eyes, which gives the 
eyes their bulged appearance. The gases that are formed 
in the brain and forced out into the tissues surrounding 
the eye do not enter the eye ball. In these cases the eye 
ball may or may not be pushed out of its socket, de- 
pending, of course, upon the amount of gases that have 
been produced. 

These gases may be removed by inserting a trocar 
inside the head at the inner angle of the eye or in the 
nose through the turbinated process of the ethmoid bone. 

After the gases have been removed from the "inside 
of the skull, about one-half pint of strong formaldehyde 
fluid should be injected. 

Another method of inserting the trocar into the brain 
would be to pass it through the forearm magnum. This 
can be done by inserting the trocar in the neck a little 
below and behind the lobe of the ear, directing the needle 
upward and inward toward the opposite eyebrow, when 
the needle will enter the subarachnoid space (Barnes 
Method). 

In cases of hydrocephalus (water on the brain) 
where there may be from one to two quarts of water in- 
side the cranium, the water may be removed by any of the 
above processes. 






CAVITY EMBALMING 249 

For ordinary cases we do not feel that it is necessary 
to make a cavity injection in the head for the reason 
that the circulation there is complete, onlv in rare in- 
stances do we find an -obstruction. 

Purging". — By purging, as the embalmer uses the term, 
is meant, the fluid which emerges from the mouth and 
nose of the cadaver. If this fluid is a brownish coffee- 
like substance, it signifies it is coming from the stomach, 
but if it is a bloody frothy mixture it signifies it is coming 
from the lungs. 

The real cause of purging is the living and growing 
saprophytic bacteria, which were normally in the body, 
or having gained access later, produce as a result of their 
development, gas formations. These gases confined as 
they are, press out from the stomach and lungs the con- 
tained fluids of the color mentioned above. 

Purging from the stomach may either be due to the 
presence of gases in the stomach itself, or in the intestines 
or in both. If the gases have formed in the intestines, 
they would dilate the canal sufficiently to fill the entire 
abdominal cavity, thus pressing the stomach against the 
diaphragm with enough force to cause the contents to 
escape through the upper end of the alimentary canal. 

Purging from the lungs is due to the presence of bac- 
teria of putrefaction, which begin to develope in the dis- 
eased portions. These cause liquefaction of the lung 
substance and the formation of gas. The gas will force 
the liquefied matter, of a bloody, frothy color out through 
the respiratory tract. 

Before embalming of the chest and the abdominal 



250 CAVITY EMBALMING 

cavity is begun the trachea and the esophagus should be 
treated in order to prevent purging. There are two 
ways of doing this: 

The first method consists of placing a ligature about 
the trachea and the esophagus, this is done by making an 
incision through the skin and tissues over the left edge of 
the trachea, one-half inch above the top of the sternum. 
Insert the right forefinger, passing it to the right side be- 
hind the trachea and the esophagus to separate the tissues 
from them. In doing this great care should be taken 
so as not to injure the carotid on the left and the in- 
nominate artery on the right side. Pass the aneurism 
hook threaded with narrow tape (this must be very 
strong tape) along the inner side of the finger, below 
the trachea and the esophagus, to the point of entrance on 
the left side. You will have no difficulty now in tying 
securely both the above tubes, and there will be no pos- 
sibility of purging from either the lungs or the stomach. 

The second method of preventing purging from the 
lungs and stomach consists in plugging the pharynx 
through the mouth, there-by plugging the trachea and 
the esophagus. The only disadvantage of this method 
is that it can not be done successfully after the body has 
been embalmed arterially. And for this reason, after 
arterial embalming, the lower jaw will be firmly set and 
to use this method, it would mean that the lower jaw must 
be pried back in order to gain access through the mouth. 
Then it will be found very difficult and in some cases 
impossible to set the lower jaw again in its proper posi- 
tion. If this method is to be used at all, it is advised 



CAVITY EMBALMING 251 

that you do the plugging of the pharynx before the ar- 
terial embalming has been done. 

To do this, take your position at the head of subject 
on the right side, and open the mouth wide enough to 
admit two fingers. Roll several pieces of dry cotton, 
the size of an English walnut, and holding the corner of 
the mouth back with the left hand, insert a ball of 
cotton with the right hand and shove it hard down be- 
hind the tongue (this can best be done with a pair of 
clamp forceps). Continue to do this until the pharynx is 
well and firmly filled, but avoid bulging out the side of 
the cheek. If properly done this plug will prevent an 
ordinary amount of purging and dry cotton seems much 
better to use for this purpose than absorbent. It must 
be borne in mind that simply filling the mouth is of no 
use; nothing is plugged by this procedure, as it leaves 
the opening into the nose open. 

If you had not anticipated purging in the beginning, 
and the body has been embalmed arterially it will be 
necessary to stop the purging by the first method. 

A third method of preventing purging from the lungs 
and stomach is in the use of plaster of paris. In this 
method the plaster of paris is mixed thinly, then by means 
of a paper funnel, pour the liquid into the nose and mouth, 
then plug tightly with absorbent cotton as in method two. 
It requires only a short time for the plaster of paris to 
set and it has been found quite successful. Probably the 
only disadvantage of this method is that it is mussy and 
because of the rapid drying qualities of the plaster of 
paris the operator must work very quickly. 



252 CAVITY EMBALMING 

The Thoracic or Chest Cavity. — Cavity embalming 
must be resorted to frequently in the chest or thoracic 
cavity for the reason that in certain diseases, especially 
tuberculosis, fluids cannot enter the diseased cavities, as 
the capillaries and small vessels are destroyed by the 
disease and the ends of the arteries securely plugged. 
If this were not so, the patient would have died of hemor- 
rhage of those arteries, a thing which seldom takes 
place. 

Again in certain other diseases, especially pneumonia, 
the fluid cannot reach the diseased lung, either through 
the nutrient arteries or by the respiratory tract, because 
of the resistance offered. The nutrient arteries will be 
filled with coagulated blood and the bronchi, to a certain 
extent, with a bloody mucous. 

This being the case, the bacteria of putrefaction will 
begin to develop within the diseased portions of the 
lungs, and will be the cause of the purging so much 
dreaded by the embalmer. 

The thoracic cavity may be treated by one of several 
methods. 

A first method consists in passing a curved trocar 
into the trachea just above the sternum and injecting a 
strong embalming fluid into the bronchi. In cases of 
gangrene of the lung, the sputum has a very offensive 
odor, which may be disinfected by this method. But 
it must be remembered that the ends of the bronchioles 
which enter the diseased parts of lungs will be closed 
(from the nature of the disease), so that any fluid in- 



CAVITY EMBALMING 253 

jected into the bronchi from the trachea will not reach 
the diseased part of the lungs. You will thus see that 
it is absolutely necessary to use a method in treating the 
thoracic cavity, whereby any mass of rotten tissue, which 
may be present, may become thoroughly saturated with 
the disinfectant. 

A second method written about the Robbins, is ac- 
complished by inserting the trocar on both the right and 
left sides at the tops of the lungs, and at the bases. At 
the top of the lungs the trocar is introduced two inches 
outside the sternum just below the clavicle. The trocar 
may then be pushed in any direction, except toward the 
sternum, without injury to any of the larger vessels. 

The arch of the aorta passes a little to the right of the 
sternum and as high as the lower border of the first rib, 
then makes a turn to the left and goes directly back to 
the left side of the fifth dorsal vertebra. The superi- 
or vena cava lies a little to the right of the arch of the 
aorta. The advantage of inserting at this point rather 
than above the clavicle is that there are no vessels in the 
location in danger of perforation. If the trocar is in- 
serted above the clavicle on either the right or the left 
side there is danger of perforating the subclavian artery 
or vein, while if the insertion is made next to the sternum, 
the aorta may be perforated, in either case breaking the 
circulation. Disease fluids are seldom found at the top 
or apexes of the lungs, but in consumption, breaking 
down of the lung substance usually begins at this point, 
especially in young cases. To insure a perfect embalm- 
ing of the lungs, you should inject at the apexes, about 



254 CAVITY EMBALMING 

a half-pint of strong formaldehyde on each side. It 
should, however, be remembered that the injection at the 
tops of the lungs, as suggested, gives no fluid to the lower 
parts of the lungs where it is often most necessary. 

It is not an unusual condition to find a whole lobe 
rotten and broken down at the base of the lung, and when 
such a diseased condition exists the lungs become firmly 
attached to the chest walls, and unless fluid is placed 
below these adhesions it does not reach the diseased parts. 
The intelligent embalmer, will never trust to the fluid 
passing from the tops of the lungs to the base, as in al- 
most all cases the adhesions between the lungs and the 
walls absolutely prevent this taking place. 

It is necessary first to draw off by aspiration, at the 
bases of the lungs, the fluids which have accumulated and 
which may be either water, pus or blood. This is done 
by inserting a curved trocar of small size, between the 
fifth and sixth ribs on the axillary line. The thoracic 
cavity extends in the back as low as the last rib and the 
twelfth dorsal vertebra and it may be necessary to pass 
the trocar down into this part of the cavity in order to 
remove the fluids. r 

As soon as the fluids are removed, inject from a pint 
to a quart of strong formaldehyde on either side. By so 
doing the .gangrenous and decomposed part of the lung 
will be put to soak in the embalming fluid, which will in- 
sure perfect disinfection and an absence of bad odors. 

Abdominal Cavity. — Often it will be found necessary 
to do cavity work in the abdominal cavity. Gases may 
arise causing a distention of the abdominal wall, re- 



CAVITY EMBALMING 255 

suiting in purging from the mouth and nose. This gas 
is the result of putrefaction and fermentation in the ali- 
mentary canal. When one of the principle arteries is 
injected, the fluid finds its way to the minute capillaries 
of the organs of the abdominal cavity, including the 
stomach and the intestines. It must be remembered that 
often there is a great amount of undigested food and 
fecal matter in the stomach and intestines. The only 
way the fluid which is in the minute capillary circulation 
of the stomach and intestines, is able to reach the inside 
of those organs and come in contact with the undigested 
food and the fecal matter is by soaking through the 
mucous wall. No doubt a certain quantity of the fluid 
does soak through, and when it does, if there is not much 
undigested food or fecal matter in these parts, disin- 
fection will be accomplished and it is in these cases that 
we do not have any trouble with distentions of the ab- 
domen. When however, there is a great amount of un- 
digested food and fecal matter inside the stomach and 
the intestinal tract, it is only obvious that enough fluid 
can not possibly soak through to disinfect, and conse- 
quently a host of putrefactive, and fermentative germs 
will begin their work, with the formation of gases and 
the distended abdomen, and perhaps purging from the 
mouth and nose. 

To prevent the formation of gas now which has arisen, 
a second injection will do no good. More drastic measures 
will have to be used. One method that has long been in 
vogue is the use of the trocar. 

The Trocar Method. — In this method a trocar varying 



256 CAVITY EMBALMING 

in length from six to fourteen inches is used. It may 
either pierce the abdominal wall through the umbilicus, or 
two inches above and two inches to the left of the um- 
bilicus. Then after the trocar has entered the abdomen 
the secret of removing gases successfully depends very 
largely upon the operator having a very correct idea of 
the location of all the abdominal organs. It is difficult 
to know when the trocar has pierced the interior of the 
stomach, or in fact even to make it pierce the stomach 
at all for the peritoneum which is a covering for all the 
organs .of the abdominal cavity contains a serous fluid 
which, makes the organs slippery, and even the sharp 
pointed trocar often does not take hold as it should. 
Again it must be remembered that the stomach is a hol- 
low organ, and for example let us try to pierce a soft 
rubber ball, containing air and a small opening, a con- 
dition resembling the stomach, with a trocar, we know 
that the one wall, will have to be pushed up against the 
other wall, and then placed against something firm, 
before the trocar will pass through. Just this condition 
happens with the stomach when the trocar tries to pierce 
the arterial wall of the stomach there is nothing solid to 
bear against and consequently the front wall will be 
pushed up against the back wall and then if enough pres- 
sure is now used to push the trocar through, it is very 
liable to pass all the way through both walls. 

Again it must be remembered that the descending 
aorta passes very close behind the stomach and should 
the trocar go all the way through the aorta might be 
pierced and the circulation in a measure ruined. The one 



CAVITY EMBALMING 257 

main disadvantage of this trocar method is that the opera- 
tor is always working blindly, it is always impossible to 
tell just how much damage may be done to the internal or- 
gans and the circulation, and again should the operator 
desire to place fluid in a certain part — say the inside of 
the intestines of ihp inside of the stomach or the colons, 
will the operator have assured knowledge that he has 
actually placed the fluid in the part desired. From the 
number of experiments that have been carried out in our 
anatomical rooms, the proof seems to be in every case that 
the fluid has not reached the part it was supposed to reach. 

The advantage of this method is the fact that by in- 
troducing the trocar into the abdominal cavity two inches 
above and two inches to the left of the navel that after 
the abdomen has been treated that the trocar then can 
be directed upward into the thoracic cavity and fluid 
there distributed to the several parts, but this is seldom 
necessary. After the trocar has been removed or better, 
just before the trocar is entirely pulled out the operator 
should sew a circular stitch about the wound and then 
as soon as the trocar is pulled out, pull the stitch closely 
together as if it were a draw string, and tie. This will 
prevent any further leakage from the part. 

The Direct Incision. — Sometimes before the body is 
embalmed or a day or two after the body has been em- 
balmed, there is a distention of the abdominal wall in- 
dicating gases and there may or may not be purging 
from the mouth and nose. From the great number of 
cases that have been posted in our anatomical labora- 
tories, it has been found that the gas that has accumu- 



258 CAVITY EMBALMING 

lated is as a rule located in either the stomach, the trans- 
verse colon, or the colons in general, but rarely in the 
small intestines to the extent that it would do much dam- 
age. By the use of the direct incision, make a cut with 
a sharp scalpel, about three inches long in the median 
line of the body over the abdomen. Start the cut about 
one inch below the ensiform process of the sternum and 
cut toward the navel. After a cut has been made three 
inches in length on the skin, direct the scalpel downward 
so that it enters the abdomen. Place the index and 
second finger in the incision thus made pressing the or- 
gans from the abdominal wall, and carefully cut upward 
between the two fingers. This will prevent the operator 
cutting any of the underlying intestines. 

The incision having been made, it is evident now that 
the part containing the gas will come up into the incision. 
If the stomach contains the gas it will come up, if the 
transverse colon contains the gas it will come up, but 
that makes no difference,' for it is the part with the gas 
that the operator is after. Usually the transverse colon 
will be the first to come up into the incision, now take 
hold of the part with your artery forceps and with a pair 
of scissors make a clip through the wall, this will let the 
gas escape. Do not let the gas escape into the room 
not deordorized, so place over the hand quickly after you 
have made the clip, a towel, or absorbent cotton that has 
been saturated with formaldehyde, this will both deodor- 
ize and disinfect the gas. Keep hold of the part until all 
the gas has escaped, and then pick up the arterial tube 
and inject a small quantity of fluid in the colon, and 



CAVITY EMBALMING 259 

then sew up with the circular stitch. Then locate the 
stomach, which can easily be found if it contains gas 
and treat it in the same way, relieving the gases and then 
placing a small amount of fluid inside. Treat the other 
several parts of the intestines in the same way if gas be 
present and it is remarkable how quickly the abdomen 
sinks to its normal level. After this has been done place 
hardening compound or common salt in the cavity, and 
placing a layer of absorbent cotton in the abdomen under 
the incision, sew up neatly. 

The one great advantage of this method is that you 
can actually see what you are doing, you can see the 
part that contains the gas and treat that part particu- 
larly, the operator is not working blindly, but is able to 
place the fluicUin the part that he desires and is assured 
of the fact that it is in the part for his eyes do not de- 
ceive him as the sense of feel and touch sometimes do. By 
this method the operator is able to surround the parts of 
the abdominal cavity with a hardening compound, and 
thus feel sure that his case if it is to be shipped, will 
be received in proper condition, at least it will be as 
far as the abdomen is concerned, if it is treated under 
this method. This method is one sure cure for purging, 
for the gases once properly relieved from the stomach 
and the contents disinfected, there is no chance for them 
to recur. If the stomach is found to be full of liquid as 
well as of gas, as is the condition during purging, the 
liquid can be taken from the stomach with a drainage tube 
or a stomach pump, and lastly every part is deodorized 
and disinfected properly. 



260 CAVITY EMBALMING 

A seeming disadvantage might be that a critic might 
suggest that you are mutilating the body with your ab- 
dominal incision. Let a fair question be asked. If it were 
your sister that was to be embalmed and gases had to be 
removed, which would you rather see some operator run- 
ning a trocar here and there through the abdomen, re- 
lieving gases and injecting fluid here and there, or, the 
use of the neat surgical incision, made as a surgeon would 
make it. 

Embalming of the Subcutaneous Tissue. — It is not 
always possible to fill the tissues of the body through the 
arterial system, the arteries may be full of blood in a 
coagulated condition so that it can not be removed, the 
walls of the arteries may be diseased, or they may be sev- 
ered at many places the result of accidental death, such as 
railroad accident, etc. If any of the above conditions be 
present or other similar conditions, it will be impossible 
to inject the arterial system, or it may be that arterial 
injection is only partly possible. In order, in arterial 
embalming, to have the tissues embalmed the fluid must 
reach the capillaries, and to fill the capillaries it is first 
necessary to fill the larger arteries. So if for any reason 
it is impossible to reach all or certain tissues by arterial 
embalming, it becomes necessary to resort to some other 
means. 

"With these difficulties then in view, the best opera- 
tion for filling the tissues, that is the subcutaneous tissue 
covering the bony framework of the body, is the direct 
injection of fluid into the part by means of (1) the hollow 
needle trocar, and (2) the hypodermic needle. 



CAVITY EMBALMING 261 

The hollow needle trocar is to be used for the rough 
work, so called. Inserting the trocar into the center of 
the popliteal space it can be pushed through the tissues 
of the foreleg, and fluid injected; then reversing, push 
the trocar through the tissues of the leg proper, and in- 
ject fluid. Inserting the trocar into the center of the 
bend of the elbow it can be pushed into the tissues of the 
forearm, and fluid injected; then reversing, push the tro- 
car through the tissues of the arm proper and inject fluid. 
Turn the body over so as to trocar. the back. Insert the 
trocar above the sacrum bone in the middle line of the 
back, and push the trocar through the fleshy parts of the 
gluteal regions, and inject fluid. Again insert the trocar 
in the middle line of the back between the two scapulae 
bones, and inject fluid into the region of the shoulders and 
the small of the back. 

After each puncture, before the trocar is removed a 
circular stitch should be thrown around the trocar and 
when the trocar is removed draw the puncture shut, the 
circular stitch acting as a draw string. 

A large amount of fluid may be injected in this man- 
ner, it being possible to inject several gallon^ into a body 
of average size. The fluid transudes through the tissues 
very readily filling them up completely, but of course, not 
as certainly as if the fluid were injected arterially. It 
is an easy matter to inject from two to three gallons of 
fluid into the soft tissues on the outside of the skeleton 
of a body weighing from 130 to 140 pounds. 

This procedure is only to be used if it is impossible to 
inject the body by the ordinary arterial embalming. The 



262 CAVITY EMBALMING 

cavity work in the cerebrospinal, the thoracic, and the 
abdominal cavity, should be done first, and then follow 
with this subcutaneous tissue outside the bony framework. 

This procedure may be used in dropsical cases and 
in certain cases, where for some reason the fluid does not 
reach a certain part, or where a certain part is not com- 
pletely supplied with fluid, by the arterial injection. 

The hypodermic needle is to be used for the more 
delicate work, such as the hands and the face. Insert the 
needle at the wrist and direct it into the palm of the hand, 
inject a very small quantity of fluid ; then into the back of 
the hand and inject a small quantity of fluid. 

To reach the tissues of the face insert the needle into 
the muscles and tissues of the face from the inside of the 
mouth. The region about the temple can be reached 
by inserting the needle into the tissues in the hair line, 
which will hide the puncture. 

With the use of the hypodermic needle fluid can be 
placed in contact with all the tissues of the hands and 
face, and the cosmetic effect will be almost perfect if the 
operator is careful as to the amount he injects, and is 
careful to see that, the fluid is equally distributed through- 
out the part. 

Plugging Orifices of the Body. — The proper manner 
in which to plug the orifices of the body is to use a pled- 
get of absorbent cotton dipped in your embalming fluid 
and forced into all the orifices, following this up with a 
pledget of dry absorbent cotton. In this the fluid dis- 
infects the surface with which it comes in contact and 
the dry cotton prevents the outgoing of the germs from 



CAVITY EMBALMING 263 

the body or the passage inward of bacteria. It must be 
understood that absorbent cotton niters out germs from 
the air, even though air passes through it, they become 
entangled in the meshes of the cotton and there remain. 

Removal of Urine. — As a rule, in the last throes of 
death, the bladder is emptied, but in some instances this 
is not done and then it becomes necessary for the em- 
balmer to remove the urine. This may be done in two 
ways. Use the steel catheter, insert it in the bladder 
through^ the urethra, and draw off the urine, or use the 
trocar and insert it through the abdominal wall in the 
median line just above, the pubic bone, directing the 
end of the trocar into the bladder which lies just below 
the pubic bone and draw off the urine. It is seldom 
necessary to inject the bladder with fluid, as after the 
urine has been removed, we find from general experience 
that it is well supplied with fluid from the arterial in- 
jection. 

In the male it is wise to tie a string about the penis 
just back of the head, or glans, while in the female it is 
best to plug the meatus of the urethra and the vagina 
with cotton. 



CHAPTER XVIII. 

THE REMOVAL OF BLOOD. 

The Removal of Blood.— In November 1882, Prof. 
J. H. Clarke and Dr. C. M. Lukens, while instructing a 
class in Philadelphia, in taking up the carotid artery, 
the internal jugular vein was injured and a flow of blood 
followed much to their dismay. This however turned 
out to be one of the greatest events that ever happened 
for the embalming profession, as it marked the beginning 
of the practice of the removal of blood from the body. 

There are some very important reasons why blood 
should be removed from the body. 

(1) There may be discolor ations on the body, es- 
pecially the face. This discoloration may be due to 
the presence of blood in the minute capillary system and 
other vessels which are near the surface skin. This 
discoloration may be due to the presence of the bile pig- 
ments in the blood, which would tend to give the body a 
yellowish hue. This discoloration may be due to the 
breaking up or disintegration of the blood corpuscles 
after death, which would tend to give the tissues of the 
body a light, pale, yellow color. Or this discoloration 
may be due to the presence of chromogenic bacteria, or 
264 



IlEMOVAL OF BLOOD 265 

color producing bacteria, in the blood, which might give 
to the tissues a characteristic green color. 

(2) There may be blood in the arterial system after 
death, which certainly will have to be removed or else it 
may be pushed into the tissues of the face during the in- 
jection of the fluid and cause a discoloration. Besides if 
the arteries are congested with blood, this will have to be 
removed to make room for the embalming fluid, so that it 
will reach the capillaries and the tissues of the body. 

(3) There may be the formation of tissue gas, and 
there is no doubt but that the removal of blood will great- 
ly facilitate in the treatment, for without the blood, the 
fluid will have more chance to act on the parts contain- 
ing the gas. This gas may be in the blood vessel itself, 
and the removal of that blood then will relieve the gas 
and the pressure exerted by the gas, which will aid in 
the injection of the fluid. 

(4) To prevent a hasty decomposition. It may be 
that our subject is very heavy and fleshy which will mean 
that there is more tissue to be preserved and necessarily 
more fluid will have to be used. To make room for this 
increased amount of fluid, blood should be removed. 

It may be that the body is in a hydropic condition. 
The tissues and the blood vessels will be filled with water. 
This will mean a hasty decomposition. The watery blood 
should be drawn from the blood vessels in order to make 
room for more fluid than ordinarily. 

It may be that the body has died of a fever, which will 
also mean a hasty decomposition. This will mean that 
the blood will soon coagulate after death, and therefore 



266 REMOVAL OF BLOOD 

the sooner it is removed, the better for the general cos- 
metic effect. 

We do not however believe that blood should be re- 
moved from every subject, in order to get good cosmetic 
effect. Rather there are times when blood should not be 
removed, the conditions which are as follows : 

(1) In the thin emaciated subject where there is no 
discoloration. An example of this condition would be 
in the tubercular subject, where before death the body has 
become very thin and emaciated. We would not remove 
blood when the subject is in this condition, for as a rule 
the body will take plenty of fluid, the arteries are as a 
rule empty after death, and besides we desire to leave 
the blood in the body, in order to give the skin of the 
face a more filled out healthy cosmetic effect. 

(2) In the pale, marble-like, anemic subject. We 
would not remove blood in this case, first because it is 
not necessary, for there is a lack of blood in the surface 
capillaries showing that the arterial system is completely 
empty, and there is no congestion of the veins; secondly, 
experience teaches us that in these cases, you probably 
would not get any blood if you did try to remove it, and 
thirdly what little blood is in the surface capillaries is 
needed to build up a more healthy cosmetic effect. 

There are times when blood should be removed from 
the subject after death which are as follows : 

(1) Whenever blood is found in the arterial system. 
An example of this might be found in those cases of sud- 
den death, such as drowning, suffocation, electric shock, 
or general heart failure. Whenever there has been a 



REMOVAL OF BLOOD 267 

case of sudden death, the operator may expect to find 
blood in the arterial system. The last contraction of the 
heart normally would drive all the blood out of the ar- 
teries and arterial capillaries into the venous capillaries 
and veins, but this is not accomplished in the cases of 
sudden death. Whenever, on incising an artery, you 
find blood in the artery, and it runs freely, it indicates 
that there is a considerable quantity of blood in the ar- 
terial system. This blood then should be removed, be- 
cause, were fluid to be injected into the artery, when it 
is full of blood and in this congested condition, all of 
this blood would be pushed ahead of the fluid toward the 
center of pressure, and from there large quantities would 
be pushed back into the tissues of the face, which would 
result in a greatly discolored face and a very poor cos- 
metic effect. DO NOT FORGET. Always remove blood 
when you find it in the arteries. The regular blood 
drainage tube should be placed in the artery, and all the 
blood removed that is possible, before attempting to in- 
ject. If this blood is not removed, the operator need not 
be surprised if he causes a decided blood discoloration of 
the face and a bad cosmetic effect. In these cases blood 
should be removed from the veins too, for that procedure 
will help to make room for what blood does remain in 
the arteries and capillaries, so that it can be pushed by 
the fluid into the veins rather than the tissues of the face. 

(2) When the venous blood vessels are congested with 
blood and gas. An example of this might be found in 
almost any case. When the operator makes the incision 
to disclose the vessels and finds the venous channels 



268 REMOVAL OF BLOOD 

congested, or when over the body the surface veins show 
signs of congestion and distention with gases, then blood 
should be removed. 

(3) In dropsical cases. Often in these cases the tis- 
sues throughout the body are in a hydropic condition 
(filled with water), the arteries as well as the veins are 
filled with a watery, bloody colored fluid. It will be 
best for the operator to remove all this watery blood 
from the arteries, veins, and the tissues also, in order to 
get the greatest amount of preservative action from his 
fluid. 

(4) In heavy, fleshy subjects. Experience teaches 
us that these bodies are as a rule difficult to handle from 
a cosmetic, as well as from a preservative standpoint. 
It seems advisable to draw blood from these subjects 
whenever possible, and by so doing bring about a clear 
non-discolored cosmetic effect ; also the removal of blood 
will give more room for a greater supply of fluid, and 
thus the tissues will be better preserved. 

(5) When the face is discolored. "Whenever the 
operator takes charge of a body and finds the face dis- 
colored, no matter what the cause of the discoloration 
may be, it is a good indication to remove blood from that 
body. 

By removing blood from the larger venous channels, 
the operator will make room for the blood to leave the 
face, and in this way better cosmetic effect is assured. 
Massage the face toward the internal jugular vein, and 
push the discoloring blood from the tissues of the face, 



REMOVAL OF BLOOD 269 

out into the larger channels, that have been emptied by 
the removal of blood. 

(6) In fever. Whenever a body dies in a high state 
of fever, it indicates a hasty coagulation of the blood, and 
a tendency to a discoloration of the face. Whenever the 
operator knows that the subject has died of a fever, or 
when there has been considerable fever on the body 
before death, then blood should be removed. 

(7) To make room for fluid. The average embalm er 
only injects a gallon to a gallon and a half of fluid into 
a body. There are times when the operator desires to 
use more fluid. It may be that the body will have to be 
shipped a long distance, perhaps to another country or 
a distant state. After a certain amount of fluid has been 
injected the vessels become filled up and there is a great 
resistance established. If the operator disregards this 
pressure, and forces still more fluid into the arterial sys- 
tem, the fine capillary network will be broken, especial- 
ly in the lung where the result will be a leakage of fluid 
through the mouth and nose from the ruptured air cells 
in the lung, or in the tissues of the skin, where the re- 
sult will be a leakage into a certain area of tissue later 
causing a condition known as leathery skin. To have 
prevented this the operator should not have forced the 
fluid beyond a certain maximum resistance. He could, 
though, have reduced this resistance by removing the 
blood from the venous system, and then succeeded in the 
further injection of fluid. 

There are times when blood ought to be removed from 
a subject after death, but for some reason it seems im- 



270 REMOVAL OF BLOOD 

possible to remove any. The reasons may be stated briefly 
as follows: 

(1) The blood may already be in a coagulated con- 
dition, owing to the fact that the body has died in a 
state of high fever. 

(2) The blood may be in a coagulated condition 
owing to the fact, that the bacteria of decomposition and 
putrefaction, have so altered the blood as to make its 
removal impossible. 

(3) Certain drugs may have been previously given, 
or taken during life which would cause a hasty coagula- 
tion of the blood. 

(4) The body may still be in a condition of rigor, 
and although the operator may have released the rigor 
in the joints, still all the tissues are in that condition, 
a condition which might prevent the blood from drain- 
ing from the veins no matter what method was used. 

Arterial blood is removed from the aorta indirectly, 
and from the arteries, only when the arterial system con- 
tains blood after death. 

Venous blood is removed from the right side of the 
heart directly or indirectly, and the veins, only when 
it is deemed necessary by the operator. 

There are two methods of removing this arterial or 
venous blood from the body. These two methods are 
aspiration and drainage. Besides these two methods some 
modified methods or combinations of the two, are given. 

Aspiration consists in actually pumping the blood 
from the heart, arteries or veins. In this method, if 
blood is to be taken from the heart directly, the trocar 



REMOVAL OF BLOOD 271 

is used; if the blood is to be taken from the heart in- 
directly or from the arteries or the veins one of the drain- 
age tubes is used. Either the trocar or the drainage 
tube is connected by rubber tubing, to the goose neck on 
the blood bottle, which in turn is connected by rubber tub- 
ing to the aspirator side of the aspirator and injector pump. 
"When the air is drawn from the blood bottle, there is a 
vacuum formed, which will aspirate or draw the blood 
from the heart directly or indirectly from the arteries or 
veins. The one great disadvantage of this method is 
that if the vaccuum is made too great, the artery or vein 
will collapse ahead of the drainage tube and thus pre- 
vent the successful aspiration of the blood. 

Drainage or gravity consists in opening one of the 
principle arteries or veins of the body, inserting a blood 
drainage tube into the artery or vein as far as it seems 
practical, and then connecting the blood drainage tube 
to the blood bottle by means of rubber tubing. The blood 
bottle should be placed considerably lower than the body 
in order to have the blood drain successfully. If the 
femoral artery or vein is used, the body ought to be on a 
considerable incline, the head at least one foot higher 
than the feet in order to get the maximum amount of 
blood. 

If the axillary, brachial, or carotid, or their corre- 
sponding veins are used, the body ought to be on a level 
or turned to the side of the opening veins. 

Simple drainage in itself is not a very successful 
method of getting the maximum amount of blood from 
the body. 



272 REMOVAL OF BLOOD 

The process can be modified in three ways which are 
as follows: 

(1) By placing the blood drainage tube in the vein 
and the arterial tube in the corresponding artery. In- 
ject fluid into the arteries which will tend to push the 
blood in turn from the capillaries into the veins, and out 
into the drainage tube into the blood bottle. This modi- 
fied method has been called by Bobbins "Displacement." 
This is a good name and one which should be generally 
adopted. 

(2) By placing the blood drainage tube in the ar- 
tery or vein, preferably the femoral, and connect it by 
means of rubber tubing to the blood bottle. The opera- 
tor now stands at the head of the subject, he reaches 
over, takes hold of each hand of the subject, raises the 
arms of the subject to right angles with the subject, then 
crosses the arms and with a steady gentle pressure bears 
down on the chest of the subject over the heart region. 

If the axillary is used the operator is able to manipu- 
late but one arm, the one opposite. Raise this arm to 
right angles with the body then fold down on the chest, 
exerting an even steady pressure. By raising the arms 
the blood will leave the hands, and each time pressure 
is exerted on the chest blood begins to flow from the 
artery or the vein, and will continue to flow as long as 
the even pressure is exerted. 

(3) By the combination of number one and two. The 
operator opens the artery, preferably the femoral in- 
serts the arterial tube, and injects a pint of fluid to exert 
a pressure on the venous system. He then opens the vein, 



REMOVAL OF BLOOD 273 

inserts the blood drainage tube which is connected with 
the blood bottle. With the pump in his right hand (grant- 
ing that he is using the aspirator and injector pump), he 
stands at the head of the subject and slowly injects the 
fluid. If at any time the blood ceases to flow, by taking 
hold of the hands, raising both arms at right angles to the 
subject, crossing, and while in this position injecting a 
few ounces of fluid, then bear down gently on the chest 
with a steady pressure. If the blood will not flow by this 
method and the operator is using either the axillary or 
the femoral, there is hardly any use of trying any other 
method. The operator will be able to draw the maxi- 
mum amount of blood with this method, if it is at all 
possible to draw blood. 

Often when the blood stops flowing, there is a blood 
clot formation ahead of the drainage tube. By injecting 
just a few ounces of fluid or salt water through the tube 
into the vein, the clot may be pushed to one side, and 
the blood will continue to flow. 

Removal of Blood from the Eight Auricle of the Heart. 
Direct Method. — Insert the trocar in the third intercostal 
space, just to the right edge of the sternum or the breast- 
bone. The trocar should be inserted obliquely, the point 
of the trocar is to pass in the general direction of the 
left hip joint, while the open end of the trocar is to point 
in the general direction of the right ear. A general knowl- 
edge of the anatomy as far as the location of the heart is 
absolutely necessary to master this procedure. The ob- 
ject is to have the point of the trocar pierce the right 
auricle of the heart. When the trocar has pierced the right 



274 REMOVAL OF BLOOD 

auricle, which the operator will have to judge through 
practice, attach rubber tubing to the gooseneck of the 
blood bottle and by the use of the aspirator pump, draw 
the blood from the heart into the blood bottle. This is 
removal of blood by aspiration. 

Removal of Blood from the Right Ventricle of the 
Heart. Direct Method. — Insert the long thin twelve or 
fourteen inch trocar two inches above and two inches to 
the left of the navel and pierce the abdominal wall, pass 
the trocar keeping the point close to the abdominal wall, 
in the general direction of the right shoulder as far as 
the lower border of the third intercostal space, without 
fear of breaking any circulation. The right ventricle will 
thus be reached from which blood can be aspirated as 
in the previous method. Here again a general knowledge 
of the anatomy as far as the location of all the organs 
in the upper abdominal and thoracic cavity is necessary 
to perform a successful operation. This is removal of 
blood by aspiration. 

Removal of Blood from the Right Auricle of the Heart. 
Indirect Method. — Make the incision for the femoral ar- 
tery and vein. 

Raise the artery and inject about a pint of fluid in 
order to cause a pressure on the venous system. Open 
the vein and insert the flexible rubber drainage tube, 
known on the market as the Red Seal drainage tube or 
the Worsham drainage tube. Push this tube up through 
the femoral, external iliac, the ascending vena cava, 
through the eustachian valve, and into the right auricle of 
the heart. 



REMOVAL OF BLOOD 275 

In order to determine when the tube is inside the right 
auricle, the operator should have laid the tube on the 
external surface of the body from the point of entrance 
to the point where the right auricle normally should be, 
allowing for the bend of the vein in its course. Mark the 
tube, then when it has been pushed into the vein to that 
point the operator is reasonably sure that the end is in 
the right auricle. 

In order to make the tube slip easily it should be 
greased with a liquid solution of vaseline. 

After the tube has reached the right auricle the blood 
may be allowed to drain, or it may be aspirated. 

Either femoral may be used, but the left femoral is 
preferable owing to the fact that, the angle at the bi- 
furcation of the ascending vena cava is more obtuse. 

If the operator desires to remove blood from the 
heart, we believe that the indirect method is the better 
way. By the use of the direct method to draw blood 
from the right auricle by means of the trocar there is 
always danger of rupturing the circulation. The aorta 
may be accidently pierced. When the trocar is inserted 
from below to reach the right ventricle the stomach may 
be punctured and the liver and diaphragm will have 
to be pierced which, too, may mean an injured circula- 
tion. If any accidental damage has been done, it can 
not be remedied. The direct method is a blind proce- 
dure and is always uncertain. On the other hand if the 
flexible rubber drainage tube is inserted into the vein it 
must follow the channel of that vein. It is more certain 



276 REMOVAL OF BLOOD 

than the trocar method and there is no danger of rup- 
turing the circulation. 

The basilic .or axillary vein may be used to remove 
blood from the heart instead of the femoral. These veins 
should be used on the left side of the body owing to the 
fact that the angle at the junction of the subclavian 
and internal jugular veins is not so acute as on the right 
side. 

Removal of Blood by the Use of the Femoral Vein. — 

The use of the femoral vein is considered by some opera- 
tors a very good method. The femoral should be em- 
ployed in the upper third. Make the incision in the 
center of Scarpa's triangle, just below Poupart's ligament. 
The incision should be about two inches in length, the 
length of the incision usually depends upon the size and 
thickness of the thigh and the depth of the vein in the 
tissue. Expose the artery and the vein. The vein at 
this point will lie to the inside of and a little below the 
femoral artery. Open the artery and inject about a pint 
of fluid to cause a pressure on the venous system. 

Have all the blood drainage outfit in readiness then 
open the vein and quickly insert the drainage tube. Any 
of the drainage tubes now commonly sold on the market 
are good. For the femoral, though, the flexible rubber 
drainage tube seems to be the best, because the femoral 
vein dips deep down into the posterior part of the ab- 
domen after it leaves the Poupart's ligament. The flex- 
ible rubber drainage tube will follow this bend and can 
be pushed as far as is desired by the operator, in contrast 



REMOVAL OF BLOOD 277 

the steel drainage tube could only be pushed into the vein 
for a few inches. 

Blood ought to drain out into the blood bottle, if it 
does not, inject a little more fluid to cause more pres- 
sure on the venous system, and if it will not flow by the 
drainage method or any of its modifications try the as- 
pirator. If blood still will not flow, it may mean that there 
is a clot ahead of the drainage tube. Pump some fluid 
through the drainage tube into the vein, to see if the 
tube is open, then let the fluid drain out which usually 
will bring some blood. After you have tried all the 
methods, if blood still does not flow, it will indicate that 
the blood is either in a coagulated condition, or there 
is not very much blood in that particular vein, which 
in this case is the femoral. The blood may be more in 
the dependent parts of the body. 

Removal of Blood from the Axillary Vein. — The ax- 
illary vein is of large size, and is formed by the junction 
of the venae comites or deep brachial veins with the basi- 
lic. The axillary vein begins at the lower part of the 
axillary space, increases in size as it ascends by receiving 
tributaries corresponding in name with the branches of 
the axillary artery and terminates immediately beneath 
the clavicle at the outer margin of the first rib where it 
becomes the subclavian vein. To remove blood from the 
axillary vein, raise the vein to the surface, and insert 
the drainage tube. The Eckels-Genung steel drainage 
tube will perhaps be the best tube to use. Insert the drain 
tube high up in the arm pit, pass through the subclavian, 
to beyond the valve located in the subclavian vein out- 



278 REMOVAL OF BLOOD 

side the point at which the internal jugular vein unites 
with the subclavian to form the innominate There being 
no more valves the blood should pass out freely. If the 
blood does not flow, raise the axillary artery, begin the 
injection of fluid which will tend to cause a pressure 
through the capillaries on the venous system pressing the 
blood back to the right auricle of the heart as in life, and 
as there is no obstructed passage the blood should flow 
freely from the tube. The vein tube is of metal having a 
plunger rod within, and a Y attachment at the upper end. 
The blood runs from the Y shaped attachment into a 
rubber tube which is connected with the blood bottle. A 
flexible arterial tube should be used in the artery, which 
will measure eight to ten inches in length and constructed 
with a shut-off valve. The tube will reach the innominate 
artery close to the arch of the aorta. With these arterial 
and drainage tubes the arms can be folded and placed 
in position, with the hands over the abdomen and the 
tubes will extend out over the upper border of the arm. 
This method will enable the operator to inject the body 
and have the arms in their natural position. If a short 
circuit through the internal mammary vessels occurs, and 
this will be evidenced by the premature flow of thin 
blood, close the vein tube now and then during the opera- 
tion, continuing the injection until the proper results are 
obtained. 

Removal of Blood from the Basilic Vein. — To with- 
draw blood from the basilic vein the left arm should be 
employed, because of a more direct route to the right 
auricle. Make the incision in the middle or the upper 



REMOVAL OF BLOOD 279 

third of the arm. The basilic vein lies in the upper arm 
and extends from the elbow to the shoulder, and can be 
found a short distance from the brachial artery, either 
above or below, but generally below and toward the 
body. Its position is not always the same, owing to the 
many anomalies that might occur. As a rule the vein is 
quite large and prominent and when secured, raise to 
the surface freeing it from the surrounding tissues. • 

Prepare two ligatures, make the incision in the vein 
and pass gently the basilic drainage tube upward toward 
the heart. Either a steel or rubber tube may be used. If 
the flexible rubber tube is used, it will find its way to the 
right auricle of the heart, its course is through the basilic, 
axillary, sub-clavian, innominate, superior vena cava, to 
the right auricle. Either the aspiration or the drainage 
methods may be used. If these fail try the displacement 
method. 

The use of the basilic for the removal of blood is fast 
disappearing from general practice. Larger veins can be 
used, which will always insure greater success. 

The Removal of Blood from the Internal Jugular Vein. 

The internal jugular vein is the largest tributary vein 
in the body, and accompanies the carotid artery. The 
operator will cut through the skin at a point from on 
half inch above the clavicle or collar bone and in the 
valley formed by the sterno-mastoid muscle to the out- 
side and the muscles of the wind pipe to the inside, cut 
upward making the perpendicular incision. Raise both 
the artery and the vein according to the usual method. 
It seems best to raise the artery and the vein together, 



280 . REMOVAL OF BLOOD 

and by so doing this will tend to give added strength 
to the vein which is very large but has quite thin walls. 
Direct the hook around the vein first then around the 
artery toward the wind pipe or trachea, raise both to 
the surface, place on the bone separator, and remove the 
sheaths. Use any of the drainage tubes. Insert the vein 
drainage tube and the arterial tube, the point of both 
tubes being directed toward the heart. The injection 
should be made slowly, which will cause the blood to 
flow from the vein through the tube and into the blood 
bottle. 

This vein is not as much used as the axillary or the 
femoral for the removal of blood. 

It is true that it is very close to the center of cir- 
culation and a gateway for the blood from the face. The 
chief disadvantage is that the vein lies quite deep, is very 
large and has such thin walls, that it is almost impossible 
to raise it without a rupture. 

About one-thirteenth of the body's weight is calcu- 
lated to be blood. Granting for the sake of argument 
that the average body that we would desire to draw blood 
from would weigh 208 pounds, then that average body 
would contain 16 pounds of blood. One pound of blood 
is practically equal to one pint, making the average body 
to contain about 16 pints of blood. 

After death about one-fourth of the blood of the body 
is found in the portal system. The portal system has 
capillaries at both ends so that it is impossible to draw 
this blood. 



REMOVAL OF BLOOD 281 

After death about one-fourth of the blood of the body- 
is found in the tiny capillaries and tissues, blood which 
by the ordinary methods used today the embalmer is 
unable to draw. 

After death about one-fourth of the blood of the 
body is found in the azygos system, and points dependent 
in the body, which blood, too, it is impossible to draw. 

This leaves about one-fourth of the blood of the body, 
which we are able to draw. One fourth of 16 pints, is 
4 pints which is the maximum we can draw from the 
average body. 

The point of this argument is that if from the aver- 
age body you have taken from two to four pints of pure 
undiluted blood, then you should be satisfied. If the 
majority of this blood has been taken from the face you 
will get the desired cosmetic effect. The claims by some 
that they are able to draw a gallon or more of blood is 
in our judgment erroneous, as we feel the blood has been 
greatly diluted. We have tested this out many times 
with the aid of control solutions and have found that 
what the embalmer would ordinarily call thin blood was 
composed of from 10 to 30% blood and from 70 to 90% 
fluid. 



PART IV. 



TREATMENTS. 

283 



Infectious Diseases 



CHAPTER XIX. 

TREATMENT OP SPECIAL DISEASES. 

Anthrax. — Synonyms. — Malignant Pustule ; Splenic 
Fever, Wool-sorter's Disease; Carbuncle; Charbons. 

Definition. — An acute infectious, non-contagious dis- 
ease, caused by the bacillus anthracis, and characterized 
by the formation of a boil with a circumscribed, infiltrated 
base and dark center, and a systemic infection of a severe 
type, the toxemia being of the gravest character. 

Pathology. — The blood is dark, thick, diffluent, and 
rich in the spores of this disease. 

Treatment. — Wash the body with 1 : 500 bichloride of 
mercury or 5% carbolic acid. Inject the arteries, using 
64 ounces of half strength fluid followed by enough 
normal fluid to secure preservation. Inject the cavities 
with normal fluid. Drain blood from the veins, and dis- 
infect the blood before disposing of it. Close the open- 
ings of the body. For transportation, govern yourself 
according to the provisions of the transportation rules. 

285 



286 TREATMENT OF SPECIAL DISEASES 

Cerebro-spinal Fever. — Synonyms. — Spotted fever ; 
Cerebro-spinal meningitis; Typhus syncopalis; Malignant 
purpuric fever. 

Definition. — An acute, infectious non-contagious 
disease, occurs sporadically, epidemically and endemically 
characterized by hyperemia of the brain and spinal cord, 
and sometimes attended by a petechial eruption. 

Cause. — The meningococcus intracellularis of Weich- 
selbaum. 

Pathology. — In those eases that speedily prove fatal, 
there are little, if any, changes in the blood or tissues 
after death. Where the disease has continued for sev- 
eral days, however, we find the characteristic sup- 
purative exudation. The sinuses of the brain contain 
blood clots. Sometimes pus is found in the internal ear, 
and the chamber of the eye. The liver, spleen and kid- 
neys are usually slightly engorged and somewhat soft- 
ened. There occurs in quite a number of cases a pe- 
techial eruption ; the purpuric spots may be quite pro- 
fuse, or but one or two may be seen. 

Treatment. — As the means of ingress and egress of 
the infectious material is not known, it is best that we 
give these cases a thorough treatment; which should 
include a full arterial injection, drainage from the vein, 
injection of the cavities, and full care of the exposed por- 
tions of the body by washing same with a 1 :500 solution 
of bichloride of mercury. The ears should be treated by 
packing them with absorbent cotton saturated with the 
fluid or with bichloride of mercury solution. The eyes 
should be carefully cleansed with a soft cloth or with 



TREATMENT OF SPECIAL DISEASES 287 

cotton saturated with bichloride of mercury solution. 
The arterial injection should consume an amount of fluid 
equal to 10 per cent, of the body weight. Give full cav- 
ity injection. Govern yourself by the regulations of 
your district for transportation of these cases. 

Erysipelas. — Synonym. — St. Anthony's fire. 

Definition. — An infectious, non-contagious disease, 
characterized by an acute and specific inflammation of the 
skin and subcutaneous tissues, attended by a shining 
redness, which spreads rapidly, marked swelling and 
pain, and which finally terminates in desquamation. 

Cause. — This disease is supposed to be caused by the 
streptococcus erysipelatis. 

Pathology. — The blood vessels are dilated and dis- 
tended with blood, the cell infiltration may extend into 
the deeper tissues with suppuration. The cocci are found 
in the lymph spaces of the affected area, also in the lymph 
vessels. There is a true dermatitis, involving the skin, 
subcutaneous, and mucous surfaces. 

Treatment. — Operator should wear rubber gloves. 
Wash the body externally with 1 : 500 solution of bichlor- 
ide of mercury using absorbent cotton in the process. If 
crusts have formed bathe the spots with sweet oil, which 
will soften them and which will allow you to remove 
them; destroying them by burning would be the best 
means of disposal. If the face be the part affected, treat 
as above and then apply the following solution to the 
part with lintine (Moadinger) or by simple saturation: 
boric acid, one drachm ; glycerine, one ounce ; water, three 
ounces. 



288 TREATMENT OF SPECIAL DISEASES 

Inject the first 64 ounces of fluid at half the normal 
strength, gradually strengthening the fluid until the tis- 
sues become firm. Drain blood freely from a large vein 
and disinfect the drawn blood before disposing of it. 
Allow the softening solution mentioned above to remain 
on the face until you are ready to place the body in the 
casket, when the face can be dried and the usual cosmetic 
powders applied. Should the peritoneum or the pleura 
be affected, inject the proper cavities with very strong 
fluid. For transportation, govern yourself according to 
the provisions of your district rules. 

Glanders. — Synonyms. — Farcy. 

Definition. — A specific, infectious, non-contagious dis- 
ease of the horse, communicable to man by inoculation, 
and characterized by the formation of nodules in the mu- 
cous membrane of the nose-glanders ; and also beneath the 
skin and lymph structures — farcy. 

Cause. — In 1882, Loeffler and Schiitz discovered the 
bacillus mallei which is the exciting cause of this dis- 
ease. The infectious material is transmitted directly 
from horse to men, usually through an abraded surface, 
and occurs most frequently among hostlers, veterinarians, 
farmers, and those who come in contact with horses. It 
has been communicated from man to man, but this is 
rare. 

Pathology. — There are found nodules located in the 
nose, in which case the disease is called glanders; or be- 
neath the skin, in which case it is called farcy. These 
nodular masses discharge a yellow pus, which will infect 
any abraded surface. 



TREATMENT OF SPECIAL DISEASES 289 

Treatment. — Disinfect the oral and nasal openings, 
and wash the body with a good germicide. Give a thor- 
ough arterial injection, using half strength fluid in the 
first bottle and normal thereafter. Drain blood from a 
large vein, disinfecting the blood before disposing of it. 
Give a complete cavity injection. Close openings. For 
transportation, govern yourself according to the provi- 
sions of the transportation rules. 

Hydrophobia. — Synonyms. — Rabies. 

Definition. — A specific infectious, non-contagious dis- 
ease peculiar to animals, especially the dog, and commun- 
icable to man by inoculation, generally by a bite. It is 
characterized in many by melancholia; great fear of 
water ; violent spasms of the pharynx and larynx, render- 
ing deglutition and respiration very difficult; great pros- 
tration, a stage of paralysis, which generally terminates 
in death. 

Cause. — The specific cause has not been determined, 
though bacteriologists agree that it is of microbic origin. 

Pathology. — The blood vessels of the cerebrospinal sys- 
tem are congested. 

Treatment. — Wash the body with 1:500 solution of 
bichloride of mercury, or 5% carbolic acid. Inject half 
strength fluid into a large artery for the first part, fol- 
lowed by enough normal fluid to secure preservation. 
Drain blood from the veins and disinfect the blood before 
disposing of it. If circulation to face and head is impaired 
through the cerebral congestion, open the common car- 
otids and inject upward ; draining from the internal jug' 



290 TREATMENT OF SPECIAL DISEASES 

ular vein. Give thorough cavity injection. Close all 
openings of the body. For transportation, govern your- 
self according to the transportation rules. 

Relapsing Fever. — Synonyms. — Typhus recurrens ; Bil- 
ious fever ; Famine fever ; Hunger pest ; Spirillum fever. 

Definition. — An acute, infectious and non-contagious 
disease, characterized by a series of exacerbations and re- 
missions, each lasting from five to seven days, and pre- 
vailing epidemically. 

Cause. — The spirillum of Obermeier. 

Pathology. — There is no characteristic change in the 
solids of the body. There is sometimes icteric discolor- 
ation during the disease and the tissues are stained after 
death. The liver, kidneys and spleen are somewhat en- 
larged. The heart becomes soft. The body retains its 
heat a long time after death and the blood coagulates 
slowly if at all. 

Treatment. — Arterial injection with half strength 
fluid, followed, in the second and third parts, with normal 
fluid. Drainage of blood. Spray fluid over abdominal 
viscera, through the usual puncture. 

For transportation of bodies dead of this disease, 
govern yourself according to the provisions of the trans- 
portation rules. 

Syphilis. — Synonyms. — Pox; mal- venereal ; lues ven- 
ereal. 

Definition. — A specific infectious, non-contagious dis- 
ease, weeks or months are occupied in its development; 



TREATMENT OF SPECIAL DISEASES 291 

» 

contracted by inoculation which is known as acquired 
syphilis, or hereditary, which is congenital syphilis, and 
is characterized by three distinct stages ; primary, second- 
ary, tertiary. 

History. — "In all probability syphilis is as old as the 
human race; for we can readily believe that illicit inter- 
course was practiced in the cities of the ancient world 
when the morals of the people were more lax than those 
of today. Our knowledge of the disease, however, dates 
from the fifteenth century. Breaking out among the 
troops of Charles VIII, King of France, it rapidly spread 
over Europe. From then to the present day our know- 
ledge of the disease has grown, till today we are able to 
classify and separate the various lesions resulting from 
illicit and promiscuous intercourse. All forms of venereal 
disease were included under the name of syphilis till 
Eicord, in 1831, demonstrated that gonorrhea and syphilis 
were two distinct diseases. " 

Etiology. — Predisposing causes are injuries or abra- 
sions of the mucous surfaces of exposed parts, for the 
disease can originate in only one way, by inoculation. 

Modes of Infection. — There are three modes of in- 
fection; illicit intercouse, heredity and accidental. Of 
these the embalmer need only consider the accidental 
form of infection. 

Pathology. — The initial lesion is the chancre, the sec- 
ondary lesions are ulceration of the mucous surfaces and 
cutaneous eruptions, and the tertiary lesions are inflam- 
matory products known as gummata, and are found upon 



292 TREATMENT OF SPECIAL DISEASES 

the bones and periosteum, or in the skin, muscles, liver, 
kidneys, lung, heart, brain; in fact in any of the viscera 
of the body. 

Treatment. — Wash body thoroughly with 5% car- 
bolic acid or 1 : 500 solution of bichloride of mercury. 
Work with rubber gloves. Inject half strength fluid for 
the first 64 ounces of fluid and follow that with normal 
fluid until disinfection and preservation are assured. 
Give the body a complete cavity injection with normal 
fluid. Drain blood from a large vein, and disinfect the 
blood before disposing of it. Close all openings of the 
body with absorbent cotton saturated with normal fluid. 
Bandage any large sores and saturate the bandage with 
normal fluid. When purpura (characterized by a blue 
spot on the face) exists, the discoloration cannot be re- 
moved. If anything is to be done at all for the discolora- 
tion, it must be of the nature of a covering for the spot, 
such as. paint or other cosmetics. For transportation of 
the body, govern yourself according to the transportation 
rules. 

Tetanus. — Synonyms. — Lockjaw ; Trismus. 

Definition. — An acute infectious, non-contagious dis- 
ease, characterized by painful spasmodic contraction of 
the voluntary muscles, most frequently those of the jaw, 
face, and neck; less frequently those of the trunk, the 
extensors of the spine and limbs. 

Cause. — The cause is recognized as the bacillus tetanus. 

Pathology. — The infection usually enters by way of 

a wound, especially of the hands and feet, and a punc- 



TREATMENT OF SPECIAL DISEASES 203 

tured wound rather than an incised one. The post-mor- 
tem lesions are not constant. 

Treatment. — The body should receive a complete ar- 
terial injection using half strength fluid for the first part 
of the injection, followed by sufficient normal fluid to 
secure preservation and disinfection. Blood should be 
drained from the veins and should be disinfected before 
being disposed of. Wash the wound with 1 :500 solution 
of bichloride of mercury and bandage it to avoid infec- 
tion from it. Inject the cavities of the body. Close the 
openings. For transportation, govern yourself according 
to the provisions of the transportation rules. 

Actinomycosis.- — Synonyms. — Big Jaw ; Lumpy Jaw. 

Definition. — A specific infectious, non-contagious dis- 
ease of domestic animals, particularly cattle, commun- 
icable to man, and caused by the ray-fungus. 

Pathology. — Infection takes place, as a rule, through 
the mouth, through a cut or abrasion of the skin 
and rarely through the respiratory tract. The fungus pro- 
duces a tumor, with a rapid proliferation of the neigh- 
boring connective tissue. The disease is not limited to 
any organ as the name lumpy jaw would imply; we may 
have actinomycosis of the lung, digestive tract, and of 
the skin. 

Treatment. — Disinfect the outside of the body by 
washing with a good germicide. Care should be exer- 
cised against inoculation through an abrasion of the skin. 
Give the body a thorough arterial injection, draining 
blood, and disinfecting the blood before disposing of it. 



294 TREATMENT OF SPECIAL, DISEASES 

Close all openings. For transportation, govern yourself 
according to the provisions of the transportation laws. 

Dengue. — Synonyms. — Break-bone fever; dandy fe- 
ver; broken-wing fever. 

Definition. — An acute, specific, infectious, non-conta- 
gious fever, occurring epidemically in tropical and sub- 
tropical climates and characterized by two severe par- 
oxysms of fever, separated by an intermission, great 
muscular pain, and usually attended by an eruption. 

Cause. — The nature of the infection or contagion 
is not known. That it is infectious is shown by the rapid- 
ity with which it spreads when once it invades a section. In 
1885, within a few. weeks, sixteen thousand, in Austin, 
Texas, were stricken. Neither age, sex, race, nor posi- 
tion exert an influence in staying the disease. 

Pathology. — As few cases prove fatal, but little oppor- 
tunity has ever been given to study its pathological char- 
acter. There has been found infiltration of the tissues 
about the joints. It is rare for a case to end fatally, only 
few succumbing to its influence. For this reason the 
embalmer will not have many of these cases to treat. 

Treatment. — As this rarely comes excepting in the 
epidemic form, that form will be treated on. The body 
should be washed with a good germicide, and all openings 
should be closed with absorbent cotton. The body should 
then receive a very heavy arterial injection, with drainage 
of blood, and cavity injection. As is the case in epidemics, 
the body should be buried as soon as possible. While the 
mortality is light, yet the most strenuous treatment should 



TREATMENT OF SPECIAL DISEASES 295 

be given to assist in the campaign of the health authorities 
against the disease and its spread. When more is known 
about the characteristics of the disease, it is likely that a 
more definite treatment can be advised. 

Malarial Fever. — Synonyms. — Ague ; Chills and fever ; 
Intermittent fever ; Swamp fever ; Marsh fever ; Paludal 
fever. 

Definition. — A specific, infectious, although non-con- 
tagious disease, caused by the hematozoa of Lavaran, and 
consisting of two distinct parts ; first, a succession of 
exacerbations and intermissions, or a series of short fevers 
separated by short intervals of health; second, a contin- 
ued fever made up of exacerbations and remissions, there 
being but one cold stage. 

Cause. — The hematozoa of Lavaran. 

Pathology. — There is a destruction of the red blood 
corpuscles, due to the action of the parasite. There is 
an increase of pigment, in the spleen, liver, kidneys, bone 
marrow, skin, and in fact, in all the tissues, due to the 
conversion of hemoglobin into pigment granules. The 
spleen is enlarged as are also the liver and the kidneys. 
The skin presents a jaundiced appearance in chronic 
malarial fever. 

Treatment. — Arterial injection of 64 oz. 1% solution 
of borax or oxalic acid followed by 64 oz. of half strength 
fluid and then a sufficient quantity of normal fluid to 
complete preservation. Drainage of blood and solution 
to wash stain from capillaries. Application of full 
strength peroxide hydrogen to face, and massage during 
injection. 



296 TREATMENT OF SPECIAL DISEASES 

For transportation of bodies dead of this disease, 
govern yourself according to the provisions of the trans- 
portation rules. 

Yellow Fever. — Synonyms. — Typhus ichteroides ; Feb- 
ris flava; Black vomit; Yellow jack. 

Definition. — An acute, infectious, though non-conta- 
gious disease of the tropics or sub-tropics, characterized 
by a high grade of fever, lasting from two to seven days, 
tenderness over the epigastrium (stomach), vomiting of 
black, broken down blood, and yellow discoloration of 
the skin. 

Cause. — Not known, although it is definitely known 
that the infection is spread through the bite of a species 
of mosquito, the stegomyia fasciata. 

Pathology. — The skin and the mucous membranes 
show a varying degree of jaundice, from a light yellow 
to a dark brownish or orange color; the color deepening 
over the course of the blood vessels. The stomach con- 
tains more or less of broken down blood, the so-called 
black vomit. The blood is dark and broken down. 

Treatment. — Arterial injection of 64 oz., of half 
strength fluid followed by sufficient normal fluid to assure 
disinfection and preservation. Drainage of contents from 
vein and massage of face with full strength hydrogen 
peroxide in an attempt to clear the complexion. Full 
abdominal cavity treatment, and close orifices of the body. 

For transportation of bodies dead of this disease, 
govern yourself according to the provisions of the trans- 
portation rules. 



TREATMENT OF SPECIAL DISEASES 297 

Diphtheria. — Synonyms. — Diphtheritis ; angina ma- 
ligna; membranous croup. 

Definition. — An acute infectious, contagious disease 
characterized by a grayish-white, fibrinous exudate, usu- 
ally located on the tonsils or the neighboring tissues. 

Cause, — This is the bacillus diphtheriae, although some 
still hold that the specific cause has not as yet been 
determined. 

Pathology, — In the severe forms the deeper connective 
tissues are involved, and there may be extensive destruc- 
tion of tissue, including the blood-vessels. There is more 
or less discoloration of the tissues from extravasation 
of the coloring matter. The kidneys and spleen may be 
enlarged. The blood is more or less broken down, the 
fibrin is deficient. 

Treatment. — Disinfect the oral and nasal cavities 
with the embalming fluid. Wash the body externally 
with 1 : 500 solution of bichloride of mercury. Inject an 
amount of fluid equaling 10% of the body weight into 
the arteries, and give cavity injection. Drain blood and 
inject additional fluid to make up for that which will be 
lost in drainage. In young persons the strength of the 
fluid for the first 64 ounces of the injection should be 
cut to half of the normal strength. Close all openings of 
the body with absorbent cotton. Dress the body and then 
place it in the casket, drawing the glass slide and clos- 
ing it, after which, it should not be re-opened. Abide by 
the regulations of your district concerning the amount 
of time to elapse between the time of death and of burial 
in these cases. For transportation govern yourself ac- 
cording to the provisions of your district rules. 



298 TREATMENT OF SPECIAL DISEASES 

Tuberculosis. — Definition. — An infectious, slightly- 
contagious disease, characterized by the formation of 
small nodules, tubercles, varying from the size of a millet- 
seed to that of a mustard-seed or even larger. 

Cause. — Tubercle bacillus of Koch. 

Pathology. — Any organ of the body may be the seat 
of the disease. In the adult the lungs are the most fre- 
quently affected, while in children the lymph glands, 
joints, and intestines are favorable seats for the disease. 
Probably the only form that will give the embalmer any 
trouble is tuberculosis of the lungs. Here either from the 
poison, developed by the bacilli, or from some other 
source, necrosis of the cells occurs, forming a cheesy con- 
dition known as caseation. At a later period this breaks 
down, forming an abscess, the cavity being filled with a 
purulent material. At other times there is a calcareous 
deposit, and the tubercular mass is said to undergo cal- 
cification. 

Treatment. — In pulmonary tuberculosis, give the body 
a complete arterial injection using half strength fluid 
for the first part of the injection, followed by three- 
fourths strength for the latter part. Hohenschuh prefers 
to drain blood from all cases ; the authors prefer to drain 
blood in tuberculosis, only when it is necessary as a means 
of preventing discolorations, and that would be in case 
the blood vessels contained much blood. Massage the 
face carefully with one of the commercial solutions, or, 
with water which of course has no bleaching action. For 
transportation, govern yourself according to the provi- 
sions of the transportation rules. 



TREATMENT OF SPECIAL DISEASES 299 

Typhoid Fever. — Synonyms. — Typhus abdominalis ; 
Typhus nervosus ; Ileo-typhus and Autumnal fever, are the 
most common terms, although Murchison's list includes 
forty others. 

Definition, — An acute, infectious and slightly conta- 
gious disease, derived from a specific cause and charac- 
terized by inflammation and generally sloughing of 
Peyer's glands, swelling of the mesentery, engorgement 
of the spleen and a rose colored eruption. 

Cause. — -A specific germ called the bacillus of Eberth 
or the bacillus typhosus. 

Pathology. — The lesions resulting from this disease 
may be divided into two parts. First, the lesions of the 
intestinal canal, Peyer's patches, the solitary glands of 
the ileum and caecum, and more rarely of the colon and 
the rectum, and changes in the spleen. Secondly, those 
lesions resulting from sepsis occurring during the long 
period of fever, and affecting the tissues and organs at 
large. The first effect of the poison or bacilli is to cause 
hyperemia (swelling) of the lymphatics, the capillaries 
become engorged and cell infiltration takes place in the 
solitary glands of the intestines. Frequently the infiltra- 
tion is so excessive that the capillaries become engorged 
and entirely choked with the infiltration. Ulcers form, 
which are shallow or deep, according to the amount of 
necrosis (sloughing), and when very deep, perforation 
of the bowel may follow, although this condition is rare. 
The spleen is nearly always involved, congestion takes 
place, followed by softening. The liver becomes hyper- 
emic, swollen and soft, and often shows abscess formation. 



300 TREATMENT OF SPECIAL DISEASES 

There is granular degeneration in the kidney, ulceration 
of the larynx and sometimes congestion of the lung. The 
heart muscles too often become weakened the result of 
the poison. 

Treatment. — If death occurs early in the disease, the 
body will not be greatly emaciated, and the following 
treatment may be followed in detail: 

If intense abdominal fermentation exists, relieve the 
accumulated gas with trocar, aspirate as much serous 
matter as possible from the pelvic cavity, introduce a 
strong fluid into the cavity, taking care to have as much 
of this fluid reach the cavities of the intestines as possible. 
Open one of the arteries commonly used in one of the 
drainage processes and inject 64 ounces of half strength 
fluid, draining blood from the vein simultaneously with 
the injection. Then inject a sufficient quantity of normal 
fluid to complete preservation. Close all openings of 
the body with absorbent cotton. Massage the face with 
water or a commercial solution during the injection. 

If death occurs late in the disease, the abdomen may 
require a stronger treatment such as we would give in 
acute peritonitis. The trocar may not prove efficient in 
reaching the affected parts and in such a case we would 
make a 4 inch incision along the median line and between 
the umbilicus and the pubic arch, exposing the ileum and 
caecum, which should be incised, their contents removed, 
and then all replaced in the cavity thoroughly surrounded 
with hardening compound. After this the wound should 
be closed with stitches. After preservation has been com- 
pleted in either this form of the disease or the one men- 



TREATMENT OF SPECIAL DISEASES 301 

tioned above, dust on a good quality of face powder to re- 
move the moist appearance from the skin. When a body 
dead of this disease is to be transported, consult the 
state or local transportation rules in addition to these 
treatments. 

Leprosy. — Definition. — A chronic, infectious, contagi- 
ous disease, which usually terminates fatally. 

Cause. — The bacillus leprae. There are tuberculous 
growths in the skin, which push outward, form nodular 
masses, between which are seen areas of ulceration and 
cicatrization, which in the face, distort the features. 
These tubercular masses discharge a thick purulent ma- 
terial. The destruction of tissue proceeds gradually, 
years being occupied in destroying a patient. The deep, 
ulcerative process may amputate fingers and toes in its 
progressive march. 

Treatment. — The body is rarely presentable for some- 
time before death, and this should not be a consideration 
in our treatment. If an arterial injection is possible, give 
it, using normal fluid for the injection. Work with rub- 
ber gloves. Give a complete cavity injection. Wrap the 
body in absorbent cotton and then in a sheet. For trans- 
portation, govern yourself according to the provisions 
of the transportation rules. 

Influenza. — Synonyms. — Epidemic catarrhal fever; la 
grippe. 

Definition. — An acute, infectious disease, the con- 
tagion of which is questionable occurring pandemically. 
Cause. — The bacillus influenza. 



302 TREATMENT OF SPECIAL, DISEASES 

Pathology. — There is no characteristic lesion in the 
uncomplicated case. When death occurs it is usually from 
complication. 

Treatment. — Disinfect the oral and nasal cavities with 
embalming fluid. Inject as much fluid as you can into 
the arteries and cavities. The usual 10% of the body 
weight must be given for transportation. If blood vessels 
are filled with blood, drain from a large vein, and add 
more fluid to your injection, to make up for the loss of 
blood to the blood bottle. Close all openings with absorb- 
ent cotton. For transportation, govern yourself accord- 
ing to the provisions of your district rules. 

Cholera. — Synonyms. — Cholera Algida; Cholera Asia- 
tica; Cholera maligna. 

Definition. — Cholera is an acute, specific, infectious 
slightly contagious disease, occurring epidemically and 
endemically, and characterized by severe vomiting and 
copious watery stools, violent cramping of the muscles 
and collapse. 

Cause. — The exciting cause is now generally recog- 
nized as the comma bacillus of Koch, or spirillum cholerae. 

Pathology. — The tissues after death are shrunken and 
drawn, and the extremities are inclined to be mottled; in 
some cases there is a postmortem rise of temperature. 
Eigor mortis sets in very early. Spasmodic contractions 
sometimes occur for some moments after death; hence 
the eyes and jaws have been seen to move after life was 
extinct. Owing to this marked contraction, the limbs 
have been distorted and the partial turning of the body 



TREATMENT OF SPECIAL DISEASES 303 

is thus accounted for, and is not, as many have supposed, 
the result of being buried alive. The tissues are dry, 
having been drained of these fluids before death, 
hence some time elapses before decomposition begins after 
death. The chief visceral lesion is that of the intestinal 
canal. The intestines contain a more or less quantity 
of rice-water, fluid rich in the comma bacillus. The blood 
is very dark, but slightly coagulable and robbed of its 
salts and fluids. 

Treatment. — Arterial and cavity embalming, closing 
all orifices of the body. Any discharges from the bowels 
should be disinfected before being disposed of. In epi- 
demics, cosmetic effect is a non-essential and in that case 
the most thorough treatment must be given without re- 
gard to appearances. 

For transportation of bodies dead of this disease, 
govern yourself according to the provisions of the trans- 
portation rules. 

Bubonic Plague. — Synonyms. — The Pest; Black 
Death; Plague of Egypt. 

Definition. — A specific, infectious, contagious disease, 
running a rapid course, and characterized by inflamma- 
iton of the glands (buboes), carbuncles, ecchymoses, and 
petechiae upon the surface. It is endemic on the eas- 
tern coast of the Mediterranean Sea and the Oriental 
countries adjacent. Epidemics occur when it spreads 
to other parts of the world, traveling along the great 
thoroughfares of travel and commerce. 

Cause. — To Kitasato belongs the honor of discovering 
the specific cause, the bacillus pestis. On entering the 



304 TREATMENT OF SPECIAL DISEASES 

body, either by inoculation or by way of the digestive 
or respiratory tracts, it multiplies with great rapidity. 
It is found in the blood, in the internal organs, in the 
intestinal canal, lymphatic glands and in great numbers 
in the suppurating buboes. 

Pathology. — Rigor mortis occurs early, and often there 
is elevation of temperature immediately after death. 
Petechiae, ecchymoses, and carbuncles are generally 
found upon the skin. The lymphatic system is generally 
affected, the lymph glands of the groin and axilla showing 
evidence of inflammation. 

Treatment. — Wash the body thoroughly with a good 
germicide, close all openings, first however, disinfect the 
oral and nasal openings. Nothing should be done for the 
ecchymotic spots, the cosmetic effect in these cases being 
secondary to disinfection. The arteries should receive a 
heavy injection of normal fluid, blood being drained from 
the veins. The blood should be disinfected before being 
disposed of. The cavities should receive a heavy injection 
of normal fluid. For transportation of these cases, govern 
yourself according to the provisions of the transportation 
rules. 

Scarlet Fever. — Synonyms. — Scarlatina; scarlet rash. 

Definition. — An acute, contagious disease, character- 
ized by a bright scarlet colored eruption, diffused over 
the entire body, terminating by desquamation of the skin. 

Cause. — Not definitely known, although thought by 
Klein and Gordon to be the streptococcus scarlatinae. 

Pathology. — The blood is dark, diffluent, and does not 
coagulate readily, owing to a defect in the fibrin. The 



TREATMENT OF SPECIAL DISEASES 305 

eruption disappears after death, except in those malig- 
nant cases where the eruption failed to appear during 
life, and appears upon the death of the patient. 

Treatment. — First protect yourself by wearing a 
bandage of surgical gauze over your mouth "and nose, then 
enter the room of death and wash the body thoroughly 
With a 1 : 500 solution of bichloride of mercury. Inject 
an amount of fluid equaling 10% of the body weight into 
the arteries and inject into the cavities. Drain blood 
through one of the drainage processes, and add an amount 
of fluid to the arterial injection equal to that which is 
lost to the blood bottle. Close all openings with absorbent 
cotton, dress the body, and then place it in the casket, 
drawing the glass slide and closing it, after which, it 
should not be reopened. Abide by the regulations of 
your district concerning the amount of time to elapse 
between the time of death and of burial in these cases. 
For intra-state and inter-state transportation, govern 
yourself according to the provisions of your district rules. 

Variola. — Synonyms. — Small-pox ; German Blattern ; 
French, La Petite Yerole. 

Definition. — A specific, infectious, highly contagious 
febrile disease, characterized by a dermatitis, in which the 
eruption passes from the papule to vesicle, and this in 
turn into pustule, finally dessicating. 

Cause. — The true nature of the virus is not known, 
and although certain microorganisms have been described 
which are found in the pock, there is no proof that they 
are responsible for producing the poison. All that is 



306 TREATMENT OF SPECIAL. DISEASES 

positively known is, that it is developed in the system 
and reproduced in the pustule. 

Pathology. — The most marked change occurs in the 
skin, where an eruption takes place, finally with the 
formation of scabs or crusts. The blood does not reveal 
any microscopic changes, although darkened in color. . . 

Treatment. — No one but an immune should handle 
these cases, and he should first wash the body with a 
1 : 500 solution of bichloride of mercury. After this has 
been done, inject an amount of fluid equal to 10 per cent. 
of the body weight, distributing same by arterial injec- 
tion. If blood is drained, and it is proper to do so, add 
fluid to the injection to make up the loss into the blood 
bottle. Give full cavity injection. Bodies dead of this 
disease should be buried within a reasonably short length 
of time, so that the apartments may be rendered safe 
by fumigation, and under no circumstances should a 
public funeral be held. After the body has been placed 
in the casket, the slide, preferably of glass, should be 
closed and should not be reopened under any circum- 
stances. Govern yourself by the regulations of your dis- 
trict for transportation of these cases. 

Measles. — Synonyms. — Morbilli ; rubeola. 

Definition. — An acute, infectious, contagious fever, 
characterized by a general papular eruption. 

Cause. — The efforts to isolate a specific germ which 
will produce the disease has thus far failed, though many 
organisms have been found in the secretions. 

Pathology. — There is a lack of coagulability of the 
blood, which is dark in color. The internal organs are 



TREATMENT OF SPECIAL DISEASES 307 

congested and softened. The lesion of the skin consists 
of an acute hyperemia with exudation in the vascular 
papillae of the corium, the sebaceous and sweat glands. 

Treatment. — Bodies rarely die from this cause ; the 
usual immediate cause of death is exhaustion. An injec- 
tion of half strength fluid for the first part of the injec- 
tion followed by normal fluid for the balance of the in- 
jection, with full cavity injection, closing the orifices is 
all that is necessary. For transportation, govern your- 
self according to the provisions of the transportation 
rules. 

Parotitis. — Synonyms. — Mumps, epidemic parotitis. 

Definition. — An acute, infectious, and contagious dis- 
ease, characterized by an inflammation of one or both of 
the parotid glands. 

Cause. — The specific cause is a contagion generated 
during the course of the disease, the exact nature of 
which is not known, although thought by some to be the 
tetrad of mumps. 

Pathology. — The parotid glands become swollen and 
hard. Death very seldom occurs from this disease. 

Treatment. — Disinfect the oral cavity with embalming 
fluid. The swelling cannot be reduced, so that the next 
concern to the embalmer will be to preserve the body. 
This should be done by injecting 64 ounces of half 
strength fluid, followed by enough normal fluid to secure 
preservation. If blood vessels contain much blood, drain 
from a large vein, and then inject additional fluid to 
make up for that lost by drainage. Close all openings 



308 TREATMENT OF SPECIAL DISEASES 

with absorbent cotton. Abide by the regulations of your 
state governing the transportation of these cases. 

Pertussis. — Synonyms. — Whooping-cough ; tussis con- 
vulsiva. 

Definition, — A specific infectious, contagious disease 
occurring epidemically, and characterized by a peculiar, 
spasmodic cough, ending in a whoop. 

Cause. — The cause of whooping-cough has always been 
a matter of conjecture. 

Pathology. — In the uncomplicated form there is no 
lesion which can be said to be characteristic. There might 
in complications be hemorrhage from the lung. 

Treatment. — Disinfect the oral and nasal cavities 
with embalming fluid. Inject 64 ounces of half strength 
fluid followed by enough normal fluid to secure preser- 
vation. If blood vessels contain much blood, drain from 
a large vein, and then inject additional fluid to make up 
for that lost by drainage. Close all openings with absor- 
bent cotton. Discourage public funerals in these cases. 
For intra-state or inter-state transportation of these 
cases, govern yourself according to the provisions of your 
district rules. 

Typhus Fever. — Synonyms. — Famine fever; Ship 
fever ; Jail fever ; Hospital fever ; and Putrid fever. 

Definition. — An acute, infectious, very contagious, 
endemic, and also epidemic disease, characterized by a 
high grade of fever and a peculiar rash. 

Cause. — Not known. 

Pathology. — The blood is dark and diffluent the re- 
sult of the intense fever and rapid work of the poison. 



TREATMENT OF SPECIAL DISEASES 309 

The liver is somewhat enlarged and softened, as are also 
the kidneys and spleen. There is an extravasation into 
the pericardium which gives it an ecchymotic appearance. 
There is also a slight engorgement and infiltration of the 
capillaries. The muscular tissues are of a dark red color. 
The skin shows a characteristic rash and ecchymotic 
spots are found on the more dependent parts of the body 
after death. 

Treatment. — Slow arterial injection and drainage of 
blood. On account of rash, apply bichloride of mercury 
1 :500. In the presence of fermentation, give the abdomen 
a special treatment. 

For transportation of bodies dead of this disease, 
govern yourself according to the provisions of the trans- 
portation rules. 

Varicella. — Synonym. — Chicken-pox. 

Definition. — An acute, specific, and infectious disease, 
characterized by an eruption that rapidly passes through 
the stage of papule, vesicle, and pustule, and terminates 
by dessication. 

Cause. — This is not known. All attempts to isolate 
the microorganisms or the contagium, whatever that may 
be, have failed. 

Pathology.— The only pathological lesion is the erup- 
tion that appears on the skin. 

Treatment — These cases should be thoroughly 
washed with 1 : 500 solution of bichloride of mercury, 
after which a thorough arterial and cavity injection 
should be given, consuming for this purpose an amount 



310 TREATMENT OF SPECIAL DISEASES 

of fluid equal to 10 per cent, of the body weight in the 
arteries. Blood should be drained from the veins, and an 
amount of fluid equal to what is lost to the blood bottle 
should be injected in addition to the 10 per cent, men- 
tioned above. After the body is placed in the casket, 
close the slide which should be of glass, and do not re- 
open again. Public funerals of these cases should be 
discouraged, to avoid the indiscriminate transfer of the 
disease. 

Septicemia. — Definition. — A morbid process commonly 
known as blood poisoning, in which there is an invasion 
of the blood by bacteria or their toxins. 

Cause. — Any bacteria or its toxin. 

Pathology. — The blood is found to be dark, diffluent, 
and rich in bacteria. The liver and spleen are soft, 
dark in color, and show swelling. The lymphatics are 
also swollen. 

Treatment. — The operator should approach these 
cases with unbroken skin on his hands, or if that be im- 
possible, with rubber gloves, as the disease is disseminated 
through abrasions. Take up a large artery and vein, 
inject half strength fluid for the first bottle and normal 
fluid thereafter in the arteries, and drain from the veins. 
Disinfect the blood obtained from the vein before dis- 
posing of it. Give the body a complete cavity injection. 
Massage the face to stimulate capillary circulation while 
the arterial injection is being made. For transportation, 
govern yourself according to your district transportation 
rules. 



TREATMENT OF SPECIAL DISEASES 3H 

Pyemia. — Definition. — An infectious disease due to 
the absorption of animal poisons, principally pyogenic 
organisms, and characterized by the formation, in the 
various tissues and organs, of multiple metastatic ab- 
scesses. 

Cause. — One of the forms or a combination of pyogenic 
micrococci are held to be responsible, for this condition. 
The streptococcus and the staphylococcus are the forms 
most common, though it is not uncommon to find the 
micrococcus lanciolatus, the gonococcus, the bacillus coli 
communis, bacillus typhosis, bacillus pyocyaneus, and 
many others. 

Pathology. — The body does not undergo putrefaction 
as rapidly as in septicemia. The first effects of the mor- 
bid changes are found in the veins, which result in 
thrombi. These thrombi are found in the various organs 
and tissues of the body. 

Treatment. — Use the precautions observed in the 
treatment for septicemia. Give the body a complete ar- 
terial injection using half strength fluid for the first bottle 
of the injection. Drain as much blood from the veins 
as possible. Thrombi may complicate the drainage, and 
if none can be obtained from several of the larger veins, 
tap the heart as a last resort. Disinfect the blood before 
disposing of it. Streptococcus infection of the embalmer 
from abrasions of the skin is very dangerous and every 
possible precaution should be carefully taken. Give the 
body a complete cavity injection. For transportation, 
govern yourself according to the provisions of the trans- 
portation rules. 



CHAPTER XX. 

TREATMENT OF SPECIAL DISEASES.— Continued. 
DISEASES OF THE RESPIRATORY SYSTEM. 

Gangrene of the Lung. — Definition. — A putrefactive 
necrosis of the lung. 

Cause. — Many putrefactive bacteria thrive in the ne- 
crotic soil, but whether they are the cause or the result 
is not known. 

Pathology. — When the gangrene is due to the plugging 
of one of the large branches of the pulmonary artery, 
a large part of the lung becomes dark, greenish brown, 
or a black fetid mass, softening rapidly in the center, 
forming an irregular cavity, containing a foul-smelling 
disgusting, greenish fluid. 

Treatment. — Give complete arterial injection. Inject 
the pleural sac on the affected side through the first inter- 
costal space or through the apex of the cavity. Spray 
fluid into the mouth and nose and close them with absor- 
bent cotton. For shipment of these cases govern yourself 
according to the transportation rules. 

Pulmonary Hemorrhage. — Synonyms. — Hemoptysis ; 
312 



TREATMENT OF SPECIAL DISEASES 313 

Broncho-pulmonary hemorrhage ; Bronchorrhagia ; Pneu- 
morrhagia. 

Definition. — An expectoration of blood, due to hemor- 
rhage from the mucous membrane of the bronchi, tra- 
chea, or larynx and from erosion or rupture of capil- 
laries in lung cavities. 

Cause. — The hemorrhage may result from congestion 
of the lungs, due either to pulmonary lesions or from 
cardiac derangements. It may accompany malignant affec- 
tions, infectious fevers, scurvy, cancer of the lung, gan- 
grene, and abscess of the lung. 

Pathology. — There is, in most cases rupture of the 
capillaries of the bronchial mucous membranes. If tuber- 
cular cavities are formed, a ruptured aneurism is some- 
times seen, or large blood vessel eroded by ulceration. If 
pulmonary apoplexy has existed, the parenchyma may 
be lacerated. 

Treatment. — Some operators wait until fluid passes 
from the mouth before taking steps to stop the hemor- 
rhage due to the injection of fluid. We prefer to use 
plaster of paris and cotton, making a paste of them and 
forcing the paste down upon the epiglottis to prevent the 
waste of fluid from that source. When the cause of death 
is known, this operation must be done before the injec- 
tion is begun or the throat will have to be dried out 
before the plaster of paris will set properly. Another 
treatment to prevent the leakage of fluid would be to tie 
off the trachea just above the upper border of the sternum. 

The body is usually emaciated and should be injected 
arterially with comparatively mild fluid, in order to avoid 



314 TREATMENT OF SPECIAL DISEASES 

drying or dessication of the features. Whenever fer- 
mentation exists in the abdomen, the cavity should be in- 
jected; otherwise it is not usually necessary. The amount 
of fluid for the injection should be based on the amount 
that will be taken by the vessels of a body the size of the 
one being injected. For transportation of these cases the 
provisions of the transportation rules should be your 
guide. 

Pulmonary Abscess. — Synonyms. — Abscess of the 
lungs; Suppurative pneumonitis. 

Definition. — A collection of pus in the lung, accom- 
panied by degeneration of tissue. 

Pathology. — The abscess may involve one or more lob- 
ules, or engage almost the entire lobe, or the abscesses 
may be scattered throughout the whole lung. 

Treatment. — Should hemorrhage occur, treat this case 
the same as for pulmonary hemorrhage. If no hemor- 
rhage occurs, give the body a complete injection with 
a mild fluid and inject the pleural sacs from the first 
intercostal space or the apex of the cavity. For trans- 
portation, govern yourself according to the provisions of 
the transportation laws. 

Pneumonia. — This disease is divided into different sub- 
divisions as follows: Lobar Pneumonia, broncho-pneu- 
monia, and chronic interstitial pneumonia. 

(A) Lobar Pneumonia. — Synonyms. — Croupous or 
Fibrinous Pneumonia; Pneumonitis; Inflammation of the 
lungs; and Winter fever. 

Definition. — This is an acute infectious disease charac- 
terized by an inflammation of the lung tissue in which 



TREATMENT OF SPECIAL DISEASES 315 

there is, first, congestion and engorgement, second, exu- 
dation or consolidation; and third, resolution or suppura- 
tion. 

Pathology. — The right lung is more frequently affected 
than the left, and one lobe, or one entire lung, rather 
than both lungs at the same time. 

Treatment. — Should suppuration occur, turn the body 
on its side, press on the sternum and cause the suppurative 
matter to leave the windpipe by purging it into the folds 
of a towel which should be placed at the mouth. Spray 
the mouth with fluid and close the oral and nasal cavities 
with absorbent cotton. 

Give the body a thorough arterial and cavity injec- 
tion, paying especial attention to the pleural sacs, which 
should be injected independently from the first inter- 
costal space on each side or from the apex of the cavity. 
Drain blood and disinfect the contents of the blood bottle 
before disposing of same. For transportation, govern 
yourself according to the provisions of the transportation 
laws. 

(B) Broncho-Pneumonia* — Synonyms. — Capillary 
Bronchitis; Lobular Pneumonia; Catarrhal Pneumonia. 

Definition. — An inflammation of the terminal bronchi, 
air vesicles, and interstitial tissue of a few or many of the 
lobules. 

Pathology. — The interstitial tissue between the air 
cells and the capillaries are greatly weakened. In most 
cases the lung will float when placed in water, though 
the small mahogany-colored nodules found distributed 
throughout the lung when excised sink in water. 



316 TREATMENT OF SPECIAL DISEASES 

Treatment. — The nature of the disease is such that 
preservation is comparatively simple, the disease affecting 
the extremities of the respiratory system. Arterial in- 
jection together with special attention to the pleural sacs 
will suffice for the cases. For transportation, govern 
yourself according to the provisions of the transportation 
rules. 

(C) Chronic Interstitial Pneumonia. — Synonyms. — 
Cirrhosis of the lungs ; Fibroid Pneumonia. 

Definition. — A chronic inflammation of the lungs, in 
which the normal air cells are replaced ' by fibrous or 
connective tissue, followed by induration and atrophy of 
the lung. 

Pathology. — The disease is nearly always confined to 
one lung, though, in very rare cases, both lungs may be 
involved, while localized areas are the rule. The affected 
lung becomes atrophied and in extreme cases, may be no 
larger than the closed hand. As a result of the shrink- 
age of the lung tissue, the heart undergoes hypertrophy. 
When tuberculosis exists, cavities of varying size and 
number are found, and the intersitial tissue between the 
capillaries and the air cells is very much weakened. 

Treatment. — Should this disease be followed by a rup- 
ture of the capillaries during the injection, thereby caus- 
ing a hemorrhage from the oral and nasal openings, treat 
it as you would a case of pulmonary hemorrhage. Other- 
wise give the body a thorough arterial and cavity injec- 
tion with special attention to the pleural sacs. For trans- 
portation, govern yourself according to the provisions of 
the transportation laws. 



TREATMENT OF SPECIAL DISEASES 317 

HydrGthorax. — Synonyms. — Thoracic dropsy ; Dropsy 
of the chest; Dropsy of the pleura. 

Definition. — A collection of serous fluid within the 
pleural cavity without inflammation. 

Pathology. — Hydrothorax, unless due to cardiac affec- 
tions, is usually bilateral. The quantity of fluid varies, 
and is generally greater on one side than on the other. 
The fluid is free, and of a low specific gravity, alkaline 
in character, clear, and of an amber color. 

Treatment. — To prevent the formation of blisters on 
the posterior surface of the thorax, aspirate the serous 
fluid from the pleural sacs, introducing the trocar through 
the apex of the cavity, and extending it into the cavity 
until it has almost reached the diaphragm. This must 
be done with both the right and left sacs. Give the body 
a complete injection, using normal fluid throughout the 
entire injection. Inject the pleural sacs after the serous 
fluid has been withdrawn. For prevention of post-oper- 
ative dangers such as bursting blisters, etc., line the cas- 
ket witn rubber for a distance of 3 inches above the 
bottom. For transportation of these cases, govern your- 
self according to the provisions of the transportation 
laws. 



CHAPTER XXI. 

TREATMENT OF SPECIAL DISEASES.— Continued. 
DISEASES OF THE CIRCULATORY SYSTEM. 

Pericarditis. — Definition. — An acute inflammation of 
the pericardium and the serous covering of the heart. 

Treatment. — Give the body a thorough injection of 
half strength fluid followed by normal fluid. Drain from 
the veins. Inject the abdominal cavity. For transporta- 
tion of these cases, govern yourself according to the pro- 
visions of the transportation rules. 

Hydropericardium. — Synonym. — Dropsy of the peri- 
cardium. 

Definition. — Hydropericardium is a non-inflammatory 
condition of the pericardium, attended by an accumula- 
tion of sero-albuminous fluid. 

Pathology. — Hydropericardium is not a disease of it- 
self, but it is always secondary. The accumulated fluid 
is usually clear, of an amber color, though it may become 
turbid by the presence of fibrin or red blood corpuscles. 
The fluid is alkaline in reaction. 

Treatment. — As this disease is always secondary to 
another, the treatment will also be secondary and all that 
318 



TREATMENT OF SPECIAL DISEASES 319 

can be said is that the heart sac should be relieved of its 
accumulated serous fluid, after the body has received the 
treatment necessary for the immediate cause of death. 
Transportation will also be covered by the disease causing 
death. 

Hemopericardium. — Definition. — Hemopericardium is 
an infiltration of blood into the pericardium. It is the 
result of a rupture of an aneurism of the aorta or coronary 
arteries, or in rare cases from rupture of the heart. It 
may also arise from injuries such as bullet wounds, frac- 
ture of the ribs, sternum, etc. 

Treatment. — This condition is usually secondary to 
another such as gun shot wound, aneurism of the aorta, 
etc., so that the treatment must be given under the head- 
ing of the immediate cause of death. For transportation 
requirements also refer to the immediate cause of death 
and the transportation rules. 

Pneumo-Pericardium. — Definition. — Pneumopericar- 
dium is an accumulation of air in the pericardium. Al- 
though this is a rare disease, it does occasionally occur, 
either through diseased processes, such as cancerous or 
tubercular ulceration or through injuries ; thus a ruptured 
pulmonary cavity might result in this condition, or the 
perforation of the esophagus, by malignant processes 
would give rise to this lesion. Sometimes pus in the 
pericardium will generate gas. 

Treatment. — As the accumulation of air or gas is 
secondary to some other process of disease, the immedi- 
ate cause of death will carry with it the proper treatment. 



320 TREATMENT OF SPECIAL DISEASES 

The gas itself should be removed by piercing the pericard- 
ium with a small needle or trocar, after which a small 
quantity of fluid should be injected. 

Endocarditis. — Definition.- — Endocarditis is an inflam- 
mation of the lining membrane of the heart, and is gen- 
erally confined to the valves, though other parts may be 
affected. 

Pathology. — The morbid changes are, first, a reddened 
and injected appearance of the endothelium, which soon 
becomes opaque and swollen from congestion of the small 
blood vessels. This swelling pr thickening of the mem- 
brane furnishes a favorable resting place for deposits of 
fibrin, and we have small, beady deposits from the size 
of a pin point to that of a pea, or even larger. These 
small, beady excrescences may become detached, and float- 
ing off in the general current, give rise to embolism in 
distant parts. 

Treatment. — An embolism means the obstruction of a 
blood vessel by some foreign material. If in the injection 
of fluid, there is an obstruction in one of the blood ves- 
sels, leading to one of the organs, you will never be any 
the wiser, but if the obstruction is in one of the vessels 
supplying a certain area of skin, the condition will show 
up sooner or later, when that certain part will have to be 
treated hypodermically. Slow arterial injection with 
drainage of blood should be given and when symptoms 
of fermentation are present, include special attention to 
the abdominal cavity. 



TREATMENT OF SPECIAL, DISEASES 321 

Aortic Incompetency. — Synonyms. — Aortic Insufficien- 
cy; Aortic Regurgitation. 

Definition. — Inability of the aortic valves to properly 
close an abnormally large aortic opening, or a change in 
the segments whereby they are shortened by curling of 
the leaflets, or by calcification. 

Treatment. — Bodies dead of this disease will be found 
with very much blood, and the elimination of the blood by 
drainage should be the first consideration along with the 
injection of fluid. The fluid should be diluted one-half 
for the first part of the injection, and sufficient fluid used 
to reach all parts of the circulatory system. It will be 
well to add fluid equal to the amount of blood and fluid 
taken from the vein to your normal injection in a body 
the size of the one to be operated on. A complete cavity 
injection should be given. For transportation, govern 
yourself according to the provisions of the transportation 
rules. 

Aortic Stenosis. — Definition. — Aortic stenosis is an ob- 
struction of the aortic orifice, due to changes in the seg- 
ments of the semilunar valves, or arterio-sclerosis, or 
atheromatous deposits. 

Treatment. — Give same treatment advised for aortic 
incompetency, with special care in the injection. Scler- 
otic conditions may complicate the injection, and in that 
case as many arteries should be injected as possible to- 
gether with full blood drainage. 

Mitral Incompetency. — Synonyms. — Mitral Regurgita- 
tion; Mitral Insufficiency. 



322 TREATMENT OF SPECIAL, DISEASES 

Definition. — This condition is an incomplete or im- 
perfect closure of the auriculo-ventricular opening, per- 
mitting the regurgitation of blood during the contraction 
of the left ventricle, and due to an abnormal condition 
of the leaflets or an enlarged opening. 

Treatment. — Give same treatment as advised for 
aortic incompetency, with special care to remove as much 
blood as possible, which, with massaging the face down- 
ward, should relieve any blood discolorations. 

Mitral Stenosis. — Definition. — Mitral stenosis is a con- 
striction of the left auriculo-ventricular orifice, usually 
due to valvular endocarditis. 

Treatment. — Give this body the same treatment as 
advised for aortic incompetency, with special care indi- 
cated in mitral incompetency. 

Tricuspid Incompetency. — Synonym.- — Tricuspid Re- 
gurgitation. 

Definition. — This condition is an imperfect closure of 
the tricuspid valves, due to dilation of the right ventricle 
or to disease of the valves. 

Treatment. — Drain as much blood as possible from 
this case. Massage the face downward, and inject the 
maximum amount of fluid; diluting the first bottle to 
half strength. In obstinate cases of blobd discoloration, 
open the common carotid arteries and internal jugular 
veins, inject upward in the arteries and drain from the 
veins, so as to wash out the vessels of the face. For 
facial injection use nothing stronger than half strength 
fluid. Give thorough cavity injection. For transporta- 



TREATMENT OF SPECIAL, DISEASES 323 

tion, govern yourself according to the provisions of the 
transportation rules. 

Tricuspid Stenosis. — Definition. — Tricuspid stenosis is 
an obstruction of the tricuspid opening, usually congeni- 
tal, though it may be acquired. 

Treatment. — Treat the same as for tricuspid incom- 
petency. 

Pulmonary Incompetency. — Synonym. — Pulmonary 
Insufficiency. 

Definition. — Pulmonary incompetency is an imperfect 
closure of the pulmonary orifice of the right ventricle due 
to changes in the pulmonary valves. 

Treatment. — Treat the same as for tricuspid incom- 
petency. 

Pulmonary Stenosis. — Definition. — Pulmonary steno- 
sis is an obstruction of the pulmonary opening of the right 
ventricle, due to congenital defects or to endocarditis. 

Treatment. — Treat the same as for tricuspid incom- 
petency. 

Cardiac Thrombosis. — Definition. — Cardiac thrombosis 
is the formation of blood clots in the cavities of the heart. 

Pathology. — The blood clots are found most frequently 
in the right side of the heart. They vary in size, from 
that of a pin head to that of a lien's egg. When degen- 
eration takes place, softening follows, and sometimes par- 
ticles become dislodged and float off to set up thrombi 
in other viscera. 

Treatment. — Remove the maximum amount of blood 
by drainage along with the injection of fluid. The fluid 



324 TREATMENT OF SPECIAL DISEASES 

in this case should be not more than half strength for 
the first part of the injection, to be followed by enough 
normal fluid to secure preservation. If thrombi have 
lodged in any of the larger arteries, the circulation to 
the part reached by the branches of the artery will be 
affected. This can be overcome by injecting an artery 
close to the part which is not receiving the fluid. Mas- 
sage the face downward to assist capillary circulation. 
Give a complete cavity injection. For transportation, 
govern yourself according to the provisions of the trans- 
portation rules. 

Hypertrophy of the Heart. — Definition. — Hypertrophy 
of the heart is an enlargement of the organ, due to an 
increase in the volume of its muscular fibers, and usually 
also to dilatation of its cavities. 

Treatment. — Secure full drainage from the veins. 
Drainage will be stimulated by an injection of half 
strength fluid for the first part of the injection and a 
massage of the face. Follow the first part of the injec- 
tion with enough normal fluid to secure preservation. 
Give a complete cavity injection. For transportation, 
govern yourself according to the provisions of the trans- 
portation rules. 

Cardiac Dilatation. — Definition. — Cardiac dilatation 
is an increase in the size of the cavities of the heart, 
due either to thickening or thinning of the walls. 

Treatment. — Treat the same as for hypertrophy of the 
heart. 

Cardiac Atrophy. — Definition. — Cardiac atrophy is a 



TREATMENT OF SPECIAL DISEASES 325 

decrease in the size, strength, weight, and activity of the 
heart. 

Treatment. — Remove blood by drainage, and inject 
half strength fluid for the first part of the injection. 
The amount of fluid need not be as great as in the acute 
disease of the heart. Massage the face downward. Give 
cavity injection. For transportation, govern yourself 
according to the provisions of the transportation rules. 

Arterio-Sclerosis.— Synonyms. — Endarteritis ; Athero- 
ma ; Arterial Sclerosis. 

Definition. — Arterio-sclerosis is an inflammatory and 
degenerative condition of the arterial system, primarily 
of the intima, although later degenerative changes may 
involve the whole structure. Calcarine deposits are quite 
common. 

Pathology. — As a result of proliferation, infiltrated 
areas begin in the middle and outer coats. These nodules 
vary in size from that of a small shot to that of a large 
coin. As they increase in size, the intima loses its smooth- 
ness and becomes thickened and rough. As these changes 
progress, the middle and outer coats are weakened. Cal- 
cification may also occur in the wall. 

In the diffuse form the change in the coats of the 
vessels extends throughout the greater part of the arterial 
system, and in some cases invades the capillaries and 
veins. 

In the senile arterio-sclerosis calcareous deposits occur, 
which render the vessels rigid. Where these tissue-changes 
involve the capillaries, there may be complete obliteration 
of their lumen in some places. 



326 TREATMENT OF SPECIAL DISEASES 

Treatment. — In some cases the artery appears to be 
closed at a point ahead of the tube and will resist the 
injection of fluid. Usually, however, the injection can 
be made without resistance. Blood should be drained 
from these cases so as to allow as full capillary penetra- 
tion as possible. When no arterial injection can be 
made, open the internal jugular and several other large 
veins, drain blood from them and then inject fluid while 
the tube is within the vessel. If necessary add a complete 
hypodermic injection to all parts of the body excepting 
the face. Give the cavities full treatment. For trans- 
portation, govern yourself according to the transportation 
rules. 

Patty Degeneration of the Arteries.— In the fatty de- 
generation of arteries the process consists in the gradual 
replacement of certain parts of the muscular cells by fat 
droplets/ The fat makes its appearance as minute drop- 
lets or granules in the cells. These granules, which are 
characterized by their dark color, gradually increase in 
number and ultimately the whole of that part of the cell 
may be transformed. During the process the granules 
coalesce, and in this manner form distinct drops of fat. 
As the process proceeds the cell is increased in size and 
becomes more globular in shape. The cell wall is de- 
stroyed and the cell may thus be converted into a mass 
of granular fat. Ultimately the matter between the gran- 
ules of fat liquify. The corpuscles break up and the fat 
becomes distributed in the surrounding tissues. The im- 
mediate effect of this fatty degeneration is to produce 
more or less softening of the fatty part, which will impair 



TREATMENT OF SPECIAL DISEASES 327 

or destroy its function. In the case of the artery, the 
internal, middle and external coats may be affected, but 
the external is the one usually first attacked. The inner 
layer or endotheleum, and the connective tissue cells in 
the deeper layers of the inner coat may become affected in 
various parts of the- vessel. The process may involve a 
great portion of the inner coat, even the whole thickness 
of the intima may be destroyed. The walls of the artery 
may be entirely solidified, the canal being closed com- 
pletely with a soft, yellowish substance as a result of the 
disease. The arter}^ might appear to be a solid mass when 
the dissecting knife is passed through. We have seen 
the anterior and posterior tibial, the popliteal, radial, 
ulnar, the aorta arteries, and especially the arch of the 
aorta thus affected. Calcification may be present at many 
places. These cases are frequently met with in old age. 

A body of this kind, where there is fatty degeneration 
of the arteries, is sometimes hard to embalm. The walls 
of the artery will be very much weakened, and too much 
pressure must not be made on them while injecting fluid. 
Inject the fluid so that it will take several hours to fill 
the tissues. The pressure should be gentle and regular 
when the aspirator and injector pump is used. If this 
precaution is taken often the whole body can be embalmed 
without a rupture of the arterial system, the fluid reach- 
ing all the extremities by means of collateral circulation. 

If the embalmer should be so unfortunate as to rup- 
ture the circulation then he will have to resort to cavity 
embalming, and the subcutaneous tissues will have to be 
embalmed by the hollow needle trocar. 



328 TREATMENT OF SPECIAL DISEASES 

Aneurism. — Definition. — An aneurism is a circum- 
scribed dilatation of an artery, formed by the giving away 
of one or more of its coats. A false aneurism is where 
there is a rupture of the coats, and the blood is found in 
the adjacent tissues. 

Treatment. — Drain blood from a large vein. Inject 
half strength fluid for the first part of the injection, fol- 
lowed by enough normal fluid to secure preservation. 
The aneurism itself, will not affect the circulation of 
fluid to any great extent. Massage the face downward. 
Give a complete cavity injection. For transportation, 
govern yourself according to the transportation rules. 



CHAPTER XXII. 

TREATMENT OF SPECIAL DISEASES.— Continued. 
DISEASES OF THE DIGESTIVE SYSTEM. 

Jaundice. — Synonym. — Icterus. 

Definition. — Jaundice is a symptom rather than a dis- 
ease, and is found in the various affections of the liver. 
It is characterized by a deposit of bilirubin in the various 
structures and fluids of the body, which gives them a 
yellow or jaundiced hue. 

Etiology. — Most pathologists agree that all the forms 
of jaundice can only come from obstruction. The ob- 
struction is due to inflammation tumefaction of the duode- 
num or bile-ducts; to foreign bodies, such as gall stones 
or parasites, within the ducts; tumors within the duct 
or by pressure from without, such as tumors, gravid 
uterus, or fecal matter ; or to stricture or obliteration 
of the duct. 

Catarrhal Jaundice. — Definition. — Catarrhal inflamma- 
tion of the lining membrane of the biliary ducts, and the 
duodenum, and attended with discoloration of the skin 
and tissues from the consequent retention and absorption 
of the bile. 

329 



330 TREATMENT OF SPECIAL DISEASES 

Pathology. — That portion of the duct lying in the 
intestines is more frequently and seriously affected, though 
the inflammation may extend to the cystic and even the 
hepatic duct. The membrane lining the ducts is swollen 
and inflamed. The liver is usually congested, slightly en- 
larged, and of a deep yellow color. The gall bladder is 
usually distended with bile. The ducts are occluded by 
the swollen mucosa and plugs of inspissated mucous. 

Discoloration of the skin and conjunctiva occurs. 
The yellow tinge begins in the eyes, forehead, and neck, 
gradually extending over the body, the color being the 
deepest in the wrinkles and folds of the skin. The color 
is generally of a lemon hue, becoming darker and assum- 
ing a bronze or greenish tint as the hepatic lesion assumes 
a graver character. 

Infantile Jaundice. — Etiology. — It is not known posi- 
tively what causes give rise to temporary jaundice in the 
new-born. Some say it is due to a reduction of blood 
pressure in the hepatic capillaries, while others say it 
is due to a stasis in the smaller bile ducts, which are com- 
pressed by the distended radicles of the portal vein. The 
severe form may be due to congenital closure or absence 
of the common or hepatic duct, to hepatic syphilis of 
congenital form, or to septic infection due to phlebitis 
of the umbilical vein. 

In the child the skin becomes a yellowish hue of 
various shades. In the severe form the hue increases 
in intensity, the skin assuming a bronze or yellowish- 
green color. The abdomen becomes full and tumid, owing 



TREATMENT OF SPECIAL, DISEASES 331 

to the congestion of the liver and spleen. "When dne to 
syphilis, there is usually skin eruption. 

Malignant Jaundice. — Synonyms. — Acute Yellow At- 
rophy of the Liver. 

Definition. — A grave form of jaundice characterized 
by neurosis of the hepatic cells and atrophy of the liver. 

Pathology. — The liver shows marked atrophy, being 
not more than two-thirds or one-half of the normal size, 
is thin, flabb}^. On making a section a yellow or a reddish 
yellow surface is presented. The hepatic cells are found 
in every stage of necrosis. Most of the organs are bile 
stained, as well as the skin, and hemorrhages are frequent. 

Treatment for Jaundice. — Since the conditions are 
similar and since the conditions after death are identical 
in reference to pigmentation, we will consider the treat- 
ment of infantile, malignant, and catarrhal jaundice under 
one head. 

The pigmentation of the skin, no matter how small, 
is the condition which presents itself most forcefully, and 
is the most annoying to the embalmer. Much study has 
been given to the subject, but with little success. It is 
claimed by some that certain fluids will bleach and bring 
out the natural color. 

A small amount of bile is sufficient to tint the surface 
of the body. Bile is composed of salts, fats, organic 
matter, acids, and also coloring matter, called the bile 
pigments. Bilirubin is the principal coloring matter, and 
when dissolved in alkali, forms, when coming in contact 
with the air and also in the dead body, a green precipitate 
known as biliverdin. The bile pigments in the blood are 



332 TREATMENT OF SPECIAL DISEASES 

carried with the serum from the capillaries to the tissues, 
being deposited in the internal coat or deep layer of the 
epidermis as well as the papillary of the dermis. The 
amount deposited regulates the extent of the pigmentation. 

One of the most beneficial things to do, where pig- 
mentation is present is to wash out the arterial system, 
draw blood from the veins, massage the exposed parts. 
Inject a diluted fluid at first, follow with a fluid of full 
strength, until complete disinfection and permeation of 
the tissues has taken place. Keep up constant massag- 
ing during the whole course of injection. This may bring 
fair results, with the addition of face tints and showing 
the body under artificial light. 

Strong solutions of formaldehyde when used at first 
are deleterious, causing the skin to become green. This 
greenness is more pronounced when chemicals such as 
methylene blue have been administered by the attending 
physician before death. Bilirubin is a red yellow color, and 
alkalies precipitate the bilirubin and form biliverdin. 
Biliverdin is a greenish color. 

All fluids contain alkalies, and are mostly alkali in 
reaction, and this may account for the greenish color of 
the skin after the injection of fluid. Acids do not pre- 
cipitate the biliverdin and there is a tendency to dissolve 
it and keep it in solution. 

Moadinger suggests that a weak solution of some 
acid be injected into the arterial system before the in- 
jection of embalming fluid. He prefers a two per cent, 
solution of oxalic acid. 

Dhonau prefers the use of a one or two per cent, solu- 



TREATMENT OF SPECIAL DISEASES 333 

tion of borax, to be injected into the arterial system, 
followed by half strength fluid, and this followed by full 
strength fluid. Dhonau also applies full strength peroxide 
of hydrogen to the skin while massaging the face. 

Eckels prefers the use of a fluid containing a peroxide. 

If methylene blue has been administered by the at- 
tending physician and you have learned this fact before 
hand, it is then not advisable to use a formaldehyde fluid. 
There is a chemical action set up between the methylene 
blue and the formaldehyde which will give to the tissues 
a greenish color which is quite objectionable. In this 
case you would inject some fluid which does not contain 
formaldehyde. A benzoate of soda or borax, or peroxide 
solution would do. 

A good formula to use, when you know methylene blue 
has been used by the attending physician is : 

Rx Carbolic acid 5 oz. 

Borax 12 oz. 

Glycerine 1 oz. 

Water, qs 1 gal. 

For transportation, govern yourself according to the 
transportation rules. • 

Cirrhosis of the Liver. — Synonyms. — Interstitial He- 
patitis; Sclerosis of the Liver; Nutmeg Liver; Hobnailed 
Liver. 

Definition. — A chronic disease of the liver, charac- 
terized by an increased connective tissue, a reduction in 
the size of the organ, and a degeneration of the paren- 
chymatous constituents. 



334 TREATMENT OF SPECIAL DISEASES 

Etiology. — In a great majority of cases the disease 
is due to alcohol, syphilis, highly spiced and very rich 
foods. Cirrhosis may result from chronic obstruction of 
the bile ducts, due to gall stones, or tuberculosis. Cirr- 
hosis frequently occurs between the ages of thirty and 
sixty years, though it may be found in the extremes of 
life. Men are more liable to contract the disease, owing 
to greater dissipations. 

Pathology. — The liver is increased in size by the in- 
crease of connective tissue, and hyperaemic. On the sur- 
face it exhibits a knobbed appearance (hobnailed liver) 
and these knobs present through the capsule a yellowish 
appearance. The granulations vary in size from a pin- 
head to a pea. As a rule there is a little jaundice, as 
there is a decrease in the production of bile, instead the 
skin takes on an earthy, sallow tint. There is gener- 
ally ascites, swelling of the feet and legs, which in- 
creases until the abdomen and the lower extremities be- 
come of an enormous size. The nutrition of the body 
suffers, the skin is dry and harsh. The blood is altered 
in quantity, and coagulates quickly. Ecchymotic spots 
appear on the skin, about the face and nose. 

Treatment. — There are probably not many other cases 
of death, which need greater skill and intelligence in 
their treatment than does cirrhosis. The condition that 
presents itself is a distended abdomen with gas and liquid. 
The limbs are also distended and the upper part of the 
body is wasted away and is greatly discolored as death 
was caused by asphyxia. 

Place the body on the board, open the femoral vein, 



TREATMENT OF SPECIAL DISEASES 335 

and insert your drainage tube. It is better to use this 
vein as it is larger, and there is more control of the re- 
moval of blood, and we would advise in this case the use 
of the flexible rubber drainage tube, which can be pushed 
up in the vein till it reaches the right auricle of the heart 
if you wish. Drain all the blood possible. Use the trocar 
method, see page 255, or the direct incision, see page 
257, to remove the gases and ascitic fluid from the ab- 
domen. Use the bandage method, see page 339 to remove 
the water from the tissue of the extremities. 

Raise the femoral artery and inject slowly a diluted 
fluid and massage the face gently toward the jugular vein, 
using some recognized face bleacher. Then follow with 
an injection of fluid of full strength until you are sure 
the fluid has permeated every tissue of the body. Do not 
be afraid to use plenty of fluid. Inject the cavities. 

For transportation, govern yourself according to the 
transportation rules. 

Carcinoma of the Liver. — Definition. — A cancerous 
growth in the liver. 

Pathology. — Jaundice is present in most cases and 
where the portal circulation is seriously compressed, as- 
cites developes. The liver is greatly enlarged, and the 
surface is nodular. 

Treatment. — As in all chronic affections of the liver, 
where the skin takes on a yellowish or bronze hue, due 
to pigmentation, it is almost impossible to bring about 
the desired cosmetic effects. The pigment is not only in 
the blood vessel but also in the tissues of the skin. 



336 TREATMENT OF SPECIAL DISEASES 

We would advise the washing out of the tissues, by 
the use of the oxalic or borax solution, injecting the 
axillary artery and draining from the femoral artery or 
raising both the carotid arteries, injecting upward on 
one side and draining from the other. 

For transportation, govern yourself according to the 
transportation rules. 

Appendicitis. — An inflammation, acute or chronic, of 
the appendix. 

Pathology. — The pathology will depend to a great 
extent upon the degree of the inflammation. Ulceration 
may take place or there may be perforation. 

Treatment. — If, after an operation, reopen the in- 
cision made by the surgeon, relieve the gas pressure on 
the intestines by incising them; surround the intestines 
with hardening compound; then inject an artery, using 
half strength fluid for the first 64 oz., followed by enough 
normal fluid to secure preservation. Drain the blood 
during the injection by one of the drainage processes. 

If no operation has been made, insert a trocar into the 
caecum to relieve the gas pressure, then inject normal 
fluid into the same place, using sufficient fluid to neutral- 
ize the process of putrefactive fermentation. The trocar 
can be first inserted in the usual place passing it to the 
caecum, or through the abdominal wall directly over the 
caecum. The arterial injection and drainage should be 
made as is mentioned above. For transportation, govern 
yourself according to the transportation rules. 

Peritonitis. — An acute or chronic inflammation of the 
peritoneum either local or general. 



TREATMENT OF SPECIAL DISEASES 337 

Pathology. — There is nearly always present more or 
less fluid in the abdominal cavity. 

Treatment. — Drain blood from a large vein, and inject 
half strength fluid for the first part of the injection, fol- 
lowing this with enough normal fluid to preserve the tis- 
sues of the body. After the arterial injection and drain- 
age have been completed, pierce the abdominal cavity in 
the usual place and draw off all the fluid that you can 
reach, paying especial attention to the lower part of the 
cavity. Then inject normal or supernormal fluid into 
the cavity to neutralize the process of putrefactive fer- 
mentation. Pierce the colons and inject fluid into them 
as well. If fermentation resists this treatment, make a 
small incision along the median line and above the um- 
bilicus, examine the stomach and intestines, incising them 
if they contain the gas. After eliminating the gas, inject 
fluid directly into them, or, surround the organs of the 
cavity with good hardening compound; sew up the in- 
cision and the body should not deteriorate in any way. 
For transportation, govern yourself according to the 
transportation rules. 

Dropsy. — Definition. — Dropsy is the accumulation of 
serous fluid in a cavity or in the tissues. 

Dropsy of the abdomen is called ascites. 

Dropsy of the chest is called hydrothorax. 

Dropsy of the peritoneum is called hydroperitoneum 
or ascites. General dropsy of the cellular tissues is called 
anasarca. 

Ascites. — Synonyms. — Dropsy of the Peritoneum ; Ab- 
dominal Dropsy. 



338 TREATMENT OF SPECIAL DISEASES 

Definition. — An accumulation of serous fluid in the 
peritoneal cavity. 

Etiology. — Any obstruction of the portal circulation 
is a possible cause of ascites, the most frequent being 
cirrhosis of the liver. Pressure from tumors or neigh- 
boring organs may also give rise to it. Peritonitis and 
valvular diseases of the heart are also responsible for 
ascites, and chronic pulmonary affections may impair the 
portal circulation to the extent of producing it. 

Pathology. — The quality and character of the fluid 
show great variation, from a few pints to several gallons, 
and from a straw or lemon tint to a brownish or greenish 
hue. It may be blood stained, and occasionally clean and 
transparent. It is usually watery in character. 

Treatment. — Use the trocar method. Insert the trocar 
through the umbilicus and draw off all the ascitic fluid 
from the abdomen, then surround the organs with a quan- 
tity of fluid sufficient to preserve them. Or if you desire, 
use the direct incision and after the ascitic fluid has 
been drawn off, surround the organs with a hardening 
compound. 

The body in general should be preserved through an 
arterial injection of normal fluid for the first 64 ounces, 
then one and one-quarter strength for all subsequent 
bottles. This, if attended by copious drainage from a 
large vein, will preserve all portions of the body excepting 
possibly the epidermis of the posterior abdominal wall, 
which, by gravitation of the ascitic fluid, will become 
separated from the derma, producing skin slip, and caus- 
ing the formation of blisters. 



TREATMENT OF SPECIAL DISEASES 339 

Previously to placing the body on the embalming 
board for treatment, a rubber cover should be placed 
over the board so that drippings of all kinds can be made 
to flow into a bucket at the lower end of the embalming 
board. When the above mentioned blisters are cut and 
their contents disposed of by gravitation into the bucket, 
a strong solution of formaldehyde should be applied to 
the affected skin to harden it and to prevent any further 
progress toward decomposition. 

In ascitic cases the casket should be lined with rubber 
or oil cloth to a point three or four inches above the 
bottom. In addition to this precaution, the use of saw- 
dust is favored so that any unlooked for breaking of 
blisters may not be attended by a flow of the ascitic 
liquid from the casket. Many embalmers do not protect 
themselves against contingencies of this kind and are 
frequently criticized by the friends and family of the 
deceased. 

Anasarca. — Definition. — Anasarca is a general dropsy 
of the cellular tissues. 

Treatment, — Bandage Method. — Bandage the ex- 
tremities of the body, commencing at the toes and finger 
tips, bandaging upward to the hip and shoulder, using 
a rubber bandage. Relieve the water as you go along, 
then rebandage, and by the third application you will 
have removed most of the water from the extremities. Do 
not leave the bandage on while injecting. 

Bandage Method. — Bandage the lower limbs, com- 
mencing with the thighs. Bandage as tight as possible 
down to the toes and make an incision in the heel, from 



340 TREATMENT OF SPECIAL DISEASES 

which drainage of the serous fluid can be secured.' In 
this method no laps are left between the bandaging so 
that the serous fluid can be forced toward the opening 
at the heel. (This method is said to be reliable, although 
we have had but little experience with it.) 

Any accumulation of ascitic fluid in the cavities should 
be removed by aspiration with the trocar, as described 
in the treatment of ascites and hydrothorax. The 
rubber cover for the embalming board as described in 
the treatment for ascites, should not be omitted. 

After the water has been eliminated as far as possible, 
the arterial injection should be made, using 64 ounces of 
normal strength fluid, followed by enough one-fourth 
strength fluid to secure preservation. Copious drainage 
will help to clear the blood vessels and allow a better 
distribution of the fluid, thereby assuring good preserva- 
tion of all parts excepting the epidermis, which is prac- 
tically closed off to the fluid by the accumulation of water 
in the subcutaneous tissue. 

In these cases the skin should receive a good applica- 
tion of strong formaldehyde fluid before and after the 
principle operation, so as to strengthen it against the 
putrefactive tendencies of the rete mucosum. 

These cases should be watched closely between the 
time of embalming and the funeral, as the most thorough 
preparation is sometimes unequal to the task of pre- 
serving the entire body in such a way as to prevent the 
formation of blisters. 

For transportation of all dropsical conditions, govern 
yourself according to the provisions of the transportation 
rules. 



CHAPTER XXIII. 

TREATMENT OF ACCIDENT CASES. 

Under this head are treated those deaths which are 
the result of accident. 

Specific Treatment of Accidents. — Broken Neck, Hang- 
ing, Strangulation. — The mode of death may possibly 
cause a separation or dividing of the blood vessels of the 
neck. If this is the case there will remain in the head 
and face a large amount of blood, which would soon be- 
come coagulated, causing a dark bluish turning black 
discoloration. The treatment then must be to get this 
blood from the face, so would recommend the common 
carotid for injection of fluid and the internal jugular vein 
for the removal of blood. 

Raise both the artery and the vein to the surface, and 
insert the arterial tube in the artery toward the face, and 
inject a small qauntity of fluid in order to cause a pres- 
sure on the venous system, then open the vein insert the 
drainage tube and begin to remove the blood, and as the 
blood drains from the drainage tube inject slowly into 
the artery. This will help to push the blood out of the 
capillary system and into the blood bottle and thus clear 
up the face of its discoloration. 

341 



342 TREATMENT OF ACCIDENT CASES 

In these cases the raising of only one common carotid 
would hardly suffice, and it would be far better to 
operate on both carotids to get the best results. For 
this reason then the circular incision would be the best 
operation, and perhaps the use of the Y shaped drainage 
tube. With the Y shaped drainage tube both sides of 
the face could be injected at the same time, and the blood 
could be removed from both internal jugular veins, and 
the operator could not help but get good results. The 
removal of blood from the internal jugulars in this di- 
rect way will relieve the pressure in the capillaries and 
smaller veins and induce a better circulation to all the 
immediate tissues. 

Body Severed. — For these cases one should have a 
very good idea of the general arterial and venous circula- 
tions of the body, for many of the smaller as well as the 
larger vessels will be cut, necessitating one to tie them 
off. 

If the body is severed below the diaphragm remove 
and cleanse all the loose and injured organs and tissues, 
place them in a bucket or pan and cover with fluid. 
Ligate all the injured arteries and veins in the upper and 
lower parts. 

Inject the lower extremities from inside the abdominal 
cavity using the common iliac artery, observing the pre- 
sence of the remaining united arteries and veins, which 
you can now see, for fluid will leak from them. The lock 
forceps will enable you to pick them up and with the 
aneurism needle dissect around the end of the vessel 
and tie each one tight. 



TREATMENT OF ACCIDENT CASES 343 

Treat the upper extremity in the same way injecting 
either from the inside or the outside, according as the 
severity of the accident may lead you to decide. Inject 
from the inside upward through the aorta, or from the 
outside either through the radial, brachial, axillary or 
carotid. 

The trunk may now be sewed together, beginning at 
the middle of the back. Sew each side up leaving the 
top open to receive the organs and the tissues which were 
removed. After these are placed more or less in position 
sprinkle hardening compound throughout the cavity. 
Now sew up the front and then place a strong bandage 
around the body. 

The Arm Severed. — Clean off the parts, and inject the 
severed part through the radial towards the hand and 
by means of collateral circulation through palmar arch, 
Vae upper part will be embalmed and the arteries that 
have been severed disclosed, when they can be tied off. 
If there is a great leakage through the stub end, and all 
the arteries can not be tied off, plaster of paris may be 
put on the stub and then a strong and tight bandage 
drawn around. 

The remaining body can then be injected through 
the opposite carotid, brachial or femoral, and when the 
leakages begin to occur at the stub end of the arm they 
can be found and tied off or if the leakage is too great 
plaster of paris may be used and a tight bandage placed 
about the stub end. 

After both the arm and the body have been injected 
the arm can now be sewed on in its natural position, 



344 TREATMENT OF ACCIDENT CASES J 

plaster of paris put around and a strong bandage placed 
around or a splint may be used on both sides. 

The Leg Severed. — Clean off the parts, and inject the 
severed part through the large dorsal toward the foot 
and by means of collateral circulation through the plan- 
tar arch, the upper part will be embalmed and the arter- 
ies that have been severed disclosed, when they can be 
tied off. If there is a great leakage through the stub end, 
and all the arteries can not be tied off, plaster of paris 
may be put on the stub and then a strong and tight band- 
age drawn around. 

The remaining body can then be injected through the 
carotid, brachial, axillary, or the opposite femoral and 
when the leakages begin at the stub end of the leg they 
can be found and tied off, or if the leakage is too great 
plaster of paris may be used and a tight bandage placed 
about the stub end. 

After both the leg and the body have been injected, 
the leg can be sewed on in its natural position, plaster 
of paris put around and a strong bandage placed around, 
or a splint may be used on both sides. 

The Head Severed. — Clean off the parts, and inject the 
head through the stub end of the carotid artery, and 
by means of collateral circulation through the circle of 
Willis, the fluid will leak through the other severed ves- 
sels and disclose them, so that they can be tied off. If 
one side of the face should take more fluid than the other 
side by this method the other carotid can be injected 
so as to equalize. It would perhaps be impossible to 



TREATMENT OF ACCIDENT CASES 345 

tie off all the tiny vessels that are severed so plaster 
of paris may be used to cover the stub end. 

To inject the body, the four principle arteries to be 
tied are the two common carotids and the two vertebrals, 
besides numerous veins and small vessels. If it is im- 
possible to tie all the severed vessels plaster of paris may 
be used, and then by injecting either through the brachial, 
axillary or femoral a thorough injection may be obtained. 
The stub end of the carotid might also be used for in- 
jection, but would not advise it as in most cases we find 
that it would be hard to get especially if the head were cut 
off close to the shoulders. 

When both the head and the body have been injected, 
bring the two parts together by using a splint in the 
vertebral column, and having plastered well together 
sew the skin. Demi-surgery can be practiced to the fullest 
extent in this case, with great cosmetic effect. 

The Head Crushed. — Remove all the coagulated blood 
and the injured parts of the brain. Cleanse the cavity 
thoroughly and remould with plaster of paris. Inject 
the best you can through one or both of the carotid arter- 
ies, and complete the injection hypodermically. Inject 
the rest of the body in the regular way, through one of the 
carotids raised for the injection of the head. With the 
practice and use of demi-surgery, all the bruised and torn 
fragments may be blended together, and the cosmetic 
effect made almost perfect. 

The Foot Crushed. — Remove all the coagulated blood 
by washing, and place all the parts together as nearly 
natural as possible. Now inject any of the principle arter- 



346 TREATMENT OF ACCIDENT CASES 

ies used in embalming, watching carefully the flow of 
fluid and blood. As soon as you see a leakage stop in- 
jecting long enough to tie it up, and when all the visible 
leakages have been thus treated, wrap the whole of the 
injured part with a bandage saturated with a plaster 
of paris solution. After this becomes dry and set com- 
plete the injection. 

The Chest Crushed. — Open up the cavity and remove 
all the injured organs and tissues, which you will place 
in a vessel containing formaldehyde fluid. With a soft 
sponge remove all the coagulated blood from the cavity. 
Now tie up all the visible arteries and start the injection 
from the inside, using first the innominate to inject the 
right arm and the right side of the face then the left com- 
mon carotid to inject the left side of the face and the 
left subclavian to inject the left arm. It must be re- 
membered though that while one artery is being in- 
jected the others should be tied off lest by collateral 
circulation you would get leakages. The thoracic aorta 
might be used but it will be found more difficult because 
of the leakages which would occur through the inter- 
costal arteries. These leakages would not occur nearly as 
much by the raising of the branches off the arch of the 
aorta, namely the innominate, the left common carotid 
and the left subclavian. Any leakage can be stopped by 
means of the lock forceps and then tied. 

The lower part of the body, if it is not injured, can 
be injected now through the abdominal aorta, but if 
there has been any damage done below the diaphragm, it 



TREATMENT OF ACCIDENT CASES 347 

would probably be best to further open up the cavity and 
inject each lower extremity through the common iliacs. 

Now replace all the organs and surround them with 
hardening compound, and sew up the cavity incisions, 
with great care and neatness. It would be well to prac- 
tice demi-surgery here, so that you would become more 
proficient in the art, and thus be able to do more efficient 
work on the exposed parts, should the occasion ever de- 
mand it. 

Gun-shot in the Abdomen. — "When death occurs it is 
generally due to severing or dividing of an artery or de- 
composition resulting from the injury done the intestines. 
The operator should open the body cavity, from the end 
of the sternum bone to the pubic bone, and cleanse the 
cavity of all the coagulated blood and other putrid matter. 
Locate and tie up the injured vessels. The injection can 
then be started from one of the principle arteries which 
will aid in locating the other injured vessels. Puncture 
the stomach and inject inside, so as to prevent the forma- 
tion of gas, and after the body has been injected place 
hardening compound inside the body cavity and sew up 
carefully and neatly. 

Burns and Scalds. — A burn is an injury to the body 
produced by the application of a flame or of a substance 
heated above a certain temperature. 

A scald is an injury produced by the application of 
a liquid heated above a certain temperature. 

Injuries resulting from corrosive liquids such as 
sulphuric acid, nitric acid, caustic potash, carbolic acid, 



348 TREATMENT OF ACCIDENT CASES 

etc., are properly termed burns. A heated solid such as 
iron may produce a burn of great intensity from -the 
blistering of the skin to the charring of the underlying 
tissues. Metals heated above 212 degrees Fahrenheit will 
produce redness, vesication and coagulation of the blood. 
Molten metals cause burns or scalds very similar to those 
produced by heated solids. Boiling oil produces severe 
burns. If a part is severely scalded with boiling water, 
the skin may appear sodden, blistered, and of an ash 
grey color, but never produces blackening or charring of 
the cuticle. Phosphorous burns are usually very severe 
and of great depth, while the area of skin destroyed is 
usually small. Gunpowder burns caused by explosions 
are often of great superficial extent, extensive scorching 
and numerous carbon particles are commonly found im- 
bedded in the true skin. Petroleum burns are generally 
severe, as usually all or nearly all the body is scorched 
and blackened. Burns from flame, extensive scorching 
with burnt hair is a usual feature in a flame burn. 
Burns from explosions of fire damp in coal mines are fre- 
quently of great extent and present the appearance of 
great scorching, and very often a quantity of coal dust 
will be found imbedded in the true skin. There are six 
degrees of burns as follows: (a) Simple hyperemia of 
the skin, (b) dermatitis, with vesicles or bullae, (c) ne- 
crosis of the superficial layer of the skin, (d) complete 
necrosis of the skin, (e) necrosis of the skin, superficial 
fascia and muscles, and (f) complete carbonization of 
the part. 

Treatment. — The embalmer does not treat these cases 



TREATMENT OF ACCIDENT CASES 349 

according to the cause as much as to what is left of the 
part after burning has been accomplished. After observing 
the part to note whether the condition can be bettered 
by a replacement of tissue by artificial means and finding 
such to be the case, I would use a form of paste com- 
monly used for filling in cuts and restoring the features 
and with this paste thoroughly cover the burned part. 
If the affected part covers the entire face or most of it, 
an entire new surface will have to be built up with the 
paste. If the burning of the skin has left particles of 
epidermis adhering to the derma, I would use sweet oil 
and bath the entire face with it, thus softening the skin 
and allowing the removal of the small particles. Any 
small desiccated spots should be covered with the paste. 
After carefully blending the paste with the skin so as 
to produce a smooth even complexion, which can best be 
done by the use of a brush to smooth it with, apply a good 
quality of face powder (flesh color) to the part. If the 
color is too striking, or too white, destroy the contrast 
with carmine rouge. This form of operation is commonly 
known as demi-surgery. We find that the face powder 
is best applied with a pad made of surgical gauze es- 
pecially when applied with a patting movement. This 
gives a good imitation of the pores of the skin, and if 
any further smoothing is necessary the brush can be used 
again. The principal result wanted is a good imitation 
of the natural parts. If the operator will use the utmost 
care to give the parts gentle, fine touches here and there, 
a most artistic effect will be produced. If the eye brows 
have been destroyed, imitate them with charcoal, carbon, 
or dark theatrical paint. A good make-up outfit is indis- 



350 TREATMENT OF ACCIDENT CASES. 

pensable for an embalmer handling many railroad cases 
during the year, and as such can be had at any dealer in 
theatrical supplies, we advise the securing of a few 
varieties of pastes, and some good face powder together 
with carmine rouge. 

If the face is damp or moist, the theatrical paste 
above mentioned will not adhere properly, and in that 
case alcohol applied to the skin will cause it to dry. One 
of the most important considerations in these cases, is 
the placing of the body in the casket. The body should 
be placed as low as possible, the silk slide should be 
closed and a view of the body only secured through it, 
the light in the room should be tempered so that no strik- 
ing rays of light serve to distort any portion of the fea- 
tures. Wonderful work has been accomplished by the 
authors and by others in rescuing cases of this kind from 
non-presentability to presentability, but in all cases, the 
ingenuity of the operator is taxed to the utmost, and the 
case never looks just right until the last touch is applied. 
With the above information, you have only the rudiments 
of the work. Your success or failure will depend upon 
how hard you try to make good in each individual case, 
and your success in matching colors, which can only be 
acquired with much patience. 

Give burned bodies a very thorough arterial injection, 
using half strength fluid for the first part of the injection. 
The cavities should also receive a good injection of nor- 
mal fluid. The peculiar odor present about a burned body 
can be lessened by the use of false deodorizers such as 
flowers, perfume, etc. 



CHAPTER XXIV. 

TREATMENT OF POSTED CASES. 

Cranial Evisceration. — By this term is meant the com- 
plete removal of the brain. To do so the scalp is cut 
from ear to ear, the front part is pulled forward over 
the nose and the back part over the occipital bone. A 
skull clamp is placed in position and with a saw take 
away the calvarium. When the calvarium or skull cap 
has been removed the brain is in full view and can be 
easily removed by cutting the arteries at the circle of 
Willis and the ligaments at the base of the skull. 

Thoracic Autopsy, — By this term is meant the com- 
plete removal of all the organs of the thoracic or chest 
cavity. To do so the skin is cut on either side from the 
sterno-clavicular junction to a point where the ninth 
rib joins to its costal cartilage. The ribs are cut on either 
side at the costochondral articulation, which will per- 
mit the entire front chest wall to be taken away. The 
heart and lungs are now in full view and can be easily 
removed. 

Abdominal Post. — By this term is meant the complete 
removal of all the organs of the abdominal cavity. To do 
so the skin and muscles are cut on either side from a 

351 



352 TREATMENT OF POSTED CASES 

point where the ninth rib joins its costal cartilage ver- 
tically downward to about an inch above Poupart's liga- 
ment and from there to the top of the pubic bone. When 
the anterior abdominal wall has been removed all the 
organs will be in full view and can easily be removed. 

Posted Cases. — By this term is meant those cases 
on which an autopsy has been held and all the internal 
organs of the body have been removed. Here all the 
internal circulation has been destroyed. 

Treatment. — Place the body on the cooling board 
and undo all the stitches made by the physician in sew- 
ing up the body after the post-mortem. Remove all the 
organs, that have been previously removed by the phy- 
sician, and place same in a bucket or other container. 
Clean out thoroughly all the blood from the cranial, 
thoracic and abdominal cavities. Now try to tie off the 
arteries in the cranial cavity which will be the verte- 
brals or the basilar and the common carotids. If these 
have been cut too short to be tied, then mix up some 
plaster of paris and cover them securely so that there 
will be no leakage. While the plaster of paris is setting 
raise the common iliac artery, which you will find at 
the back of the abdomen just over the ilio-psoas muscle, 
represented by a line drawn from the body of the fourth 
dorsal vertebra to the center of Poupart's ligament. 
Inject the right and left common iliac arteries downward 
which will take care of the lower extremities. Here the 
only artery you need to tie off is the deep epigastric 
artery which is a branch of the external iliac just a short 
distance above Poupart's ligament and which takes a 



TREATMENT OF POSTED CASES 353 

course upward over the abdominal muscles finally to 
anastomose with the deep mammary artery. 

By the time you have injected the lower extremities, 
the plaster of paris will be set. Work from the inside of 
the thoracic cavity, and tie off the innominate, left com- 
mon carotid and the left subclavian arteries, and when 
this has been accomplished inject each one separately. 
Here the only leakage you will have will be through the 
mammary or intercostal arteries which you will tie off 
as the leakage occurs. 

Now turn the body over and hypodermic the back, 
then turn body over again. Fill the cranial cavity with 
sawdust, place the skull cap in position and sew up the 
scalp. "Wash all the organs and place them back in the 
cavities in their proper positions or as nearly so as possible 
and as you do so fill in with hardening compound. Sew 
up the abdomen and wash the body with a disinfecting 
solution and apply outward cosmetics. 



CHAPTER XXV. 

TREATMENT OF MISCELLANEOUS CASES. 

Alcoholism. — Definition. — An intoxication, acute or 
chronic, due to the injection of a sufficient quantity of 
alcohol to produce muscular inco-ordination, mental dis- 
turbances, and finally narcosis. 

Pathology. — Where death is the result of acute al- 
coholism, the mucous membrane of the gastro-intestinal 
canal is engorged, injected, and dark red in color, and 
covered with a sticky, mucoid exudate. The brain and 
the kidneys show the same characteristic changes. In 
chronic alcoholism, changes of a more permanent char- 
acter take place, depending somewhat upon the quantity, 
quality and kind of alcoholics consumed, and the length 
of time used. While all the bodily tissues are more or less 
impaired, the brain, kidneys, and digestive system suffer 
most. There may be connective tissue changes, fatty de- 
generation, sclerosed kidneys, liver or arteries, and a 
more or less dilatation of the stomach. 

Treatment. — In acute alcoholism, the blood should 
be drained from a large vein, while fluid is being injected 
into a large artery. After draining a sufficient amount of 
blood from the body, the vein tube should be shut off 
354 






TREATMENT OF MISCELLANEOUS CASES 355 

and the arterial injection should continue until the cap- 
illaries have been filled to their utmost capacity. This 
strong treatment is advised on account of the early ten- 
dencies toward putrefaction, which is sometimes in an 
advanced state shortly after death. The cavities should 
receive a thorough treatment with normal or supernormal 
fluid. Myers advises the re-injection of the cavity in 6 
or 8 hours after removing the fluid remaining in the 
cavity from the first injection. As a preventive treat- 
ment, this last is a wise precaution. While the cavity 
treatment is being given the stomach should be entered 
by the trocar, relieved of its contents and injected, thus 
preventing post-operative purging. 

In chronic alcoholism, the greatest circulation diffi- 
culties will be encountered. The capillaries will not re- 
ceive the fluid, the putrefactive processes causing the for- 
mation of tissue gas early in the case, which, when 
coupled to many natural impediments to the circulation 
in cases of this kind, virtually nullifies the circulation for 
fluid distribution. Inject as many arteries as possible, 
and if necessary the veins also. Use the hollow needle 
or trocar and give the unexposed portions of the body a 
heavy hypodermic injection. The fluid used in this case 
should be not less than normal in strength and in most 
cases should be at least % over normal. Give the cavities 
a very heavy injection, paying special attention to the 
food passages. This is one of the cases coming to the at- 
tention of the embalmer where every emphasis must be 
laid upon the injection of a sufficient amount of fluid, 
through as many channels as possible. Do not count the 
cost of the fluid in this case, if you value the securing of 



356 TREATMENT OF MISCELLANEOUS CASES 

satisfactory results. Cosmetic effect will be enhanced by- 
injection of the carotids upward with drainage from the 
internal jugular veins. Finish the case with the use of 
good face powder, unless a discoloration is present, when 
this should be obliterated with one of the improved 
methods mentioned in the chapter on discolorations. 

Morphinism. — Definition. — A chronic intoxication due 
to the habitual use of opium, or some of its alkaloids, 
especially morphine. 

Pathology. — There are no characteristic tissue 
changes, other than that due to indigestion and malnu- 
trition. At death the patient is anemic, the skin dry, 
sallow and inelastic, the heart and blood vessels show 
the effects of poor nutrition, and the tissues generally 
present a starved appearance. The blood disintegrates, 
causing a discoloration of a brownish color, one or two 
days after death. 

Treatment. — Drain blood from these cases using half 
strength fluid for the first part of the injection. The more 
blood obtained, the less the danger of discoloration will 
be. Give the body a thorough cavity injection in addi- 
tion to the arterial injection. If your treatment does not 
eliminate the blood as a factor, the discoloration will 
occur and then it cannot possibly be removed. In this 
case the use. of cosmetics, if in the hands of a patient 
operator, will overcome the color. 

Plumbism. — Synonyms. — Lead-poisoning. 

Definition. — A chronic intoxication due to absorption 
of lead. 



TREATMENT OF MISCELLANEOUS CASES 357 

Pathology. — The muscles are atrophied and pale in 
color. Arteriosclerosis of the cerebral blood vessels is 
found. There may be softening of the brain and hemor- 
rhage. 

Treatment. — Drain blood from the veins while inject- 
ing fluid in the arteries. The fluid should be used half 
strength for the first bottle of the injection. Massage 
the face downward to help eliminate any discoloration 
of blood origin from cerebral hemorrhage. Give the body 
a thorough injection both as to arteries and cavities. If 
the face is unduly pale from this treatment, carmine 
rouge, judiciously applied will lessen the paleness. 

Arsenicism. — Definition. — A chronic intoxication 
caused by the continued absorption of arsenic. 
Treatment. — Same as for plumbism. 

Mercurialism. — Definition. — A chronic mercurial poi- 
soning, caused, either by ingestion of the drug, or by in- 
halation and absorption of the mineral in the industrial 
pursuits. 

Pathology. — There is an acute inflammation of the 
mouth, stomach, and intestines. The kidneys are inflamed 
and the liver is degenerated. 

Treatment. — Drain blood from a large vein while the 
injection is going on. The first bottle of fluid for the in- 
jection should be half strength. The cavities should be 
injected, as intense inflammation takes place in the ali- 
mentary tract. 

Heat-Stroke — Synonyms. — Sunstroke. 

Definition. — Heat-stroke is the result of exposure to 



358 TREATMENT OF MISCELLANEOUS CASES 

intense heat, either from the direct rays of the sun, or the 
radiation of blasts or furnaces, or to an overheated at- 
mosphere. 

Pathology. — Owing to the excessive heat of the body, 
putrefactive changes occur very early. If a post-mortem 
examination is made very soon after death, the left heart 
will be found contracted, while the right heart will be 
engorged, and the venous trunks filled with dark semi- 
fluid blood. There is also venous engorgement of the 
brain, spinal cord, and lungs. Ecchymoses and extravasa- 
tions of blood are found in the skin and mucous mem- 
branes. 

Treatment. — Drain blood from a large vein during the 
injection. The first two bottles of the injection should be 
of half strength fluid. The face should be massaged to 
assist in the securing of capillary circulation and in the 
elimination of the blood discoloration. The body should 
be treated as soon as possible after death, as putrefaction 
begins early. The cavities should have a very thorough 
treatment, eliminating the gases and injecting normal 
fluid therein. Should ecchymosis occur, obliterate the 
color by an application of cosmetics. 

Obesity. — Definition. — An excessive accumulation of 
fat, impairing the bodily functions, or rendering one un- 
comfortable. 

Treatment. — Drain blood from these cases, injecting 
the first bottle of fluid half strength followed by normal 
fluid for the balance of the injection. Massage the face 
downward during the injection. Inject the cavities, with 
special attention to the stomach and intestines. For 



TREATMENT OF MISCELLANEOUS CASES 359 

transportation of these cases, govern yourself according 
to the provisions of the transportation laws. 

Elephantiasis. — Definition. — A chronic disease caused 
by inflammation and obstruction of lymphatics and 
marked by great thickening of the skin. 

Treatment. — Drain blood from these cases and inject 
normal fluid sufficient enough in quantity to secure preser- 
vation. For long time preservation, supplement the fore- 
going treatment by a special injection into the thickened 
extremity, either through an artery leading directly to 
the part or by trocar or hollow needle inserted under 
the skin. Give the body a thorough cavity treatment, 
using normal fluid throughout. For transportation, 
govern yourself according to the provisions of the trans- 
portation laws. 

Drowned Cases. — Treatment. — Inject fluid into the 
lungs by inserting a child's trocar into the windpipe at 
the upper border of the sternum, making the injection 
sufficient in strength and amount to fill the lungs. If this 
is not done, a bloody purging will take place several 
hours after death. Tap the stomach through the epigas- 
tric region, aspirate the contents and inject strong fluid 
before removing the instrument. Drain blood from the 
body during the injection, which should be quite heavy 
and of normal fluid. The last bottle should be made \ l /i 
strength or J^ over normal. 

Floater — Definition. — A body that has been floating 
on the water. 

Treatment. — The body is distended with gases in the 
cavities, tissues and capillaries, putrefaction is in an ad- 



360 TREATMENT OF MISCELLANEOUS CASES 

vanced state, and a vile odor will be present. If body is 
to be shipped, aspirate all the gas possible from the tis- 
sues with the hollow needle, injecting strong fluid in the 
same openings. Open the body from the base of the neck 
to the pubic bone, relieve the gases in the alimentary 
tract and lungs, and fill cavity thoroughly with harden- 
ing compound, after which it should be sewed up. Inject 
as many arteries as possible with very strong fluid. Dress 
the body and place it in a metallic casket. Pour the con- 
tents of two pound bottles of Piatt's chlorides on the 
underclothing to assist in deodorizing the body. Do not 
open the casket after it is once sealed. 

If the body is not to be shipped, it will be advisable 
to deodorize it as much as possible and bury it without 
delay. 

Mother and Unborn Child. — Mother and Foetus in 
Utero. — Treatment. — Before pregnancy has reached the 
three months stage, the child will receive fluid directly 
from the circulation connected with the mother. 

After the three months stage, the circulation, by direct 
flow, is stopped and fluid could only reach the foetus by 
absorption from the placenta. This is naturally insuf- 
ficient to preserve the child, which by this time is im- 
mersed in the liquor amnii (water of the womb) and 
which is subject to early putrefaction in that situation. 
The trocar should be directed to the uterus or womb 
from a point on the median line, half way from the um- 
bilicus to the pubic arch, care being taken to reach the 
water which surrounds the foetus. Withdraw the water, 
and inject as much strong fluid as possible so that the 



TREATMENT OF MISCELLANEOUS CASES 361 

foetus will be surrounded with fluid, and in that way- 
preserved. If the trocar enters the body of the child, this 
will not occur, so the instrument should be carefully ma- 
nipulated to reach the space between the child and the 
uterine wall. The mother should receive a very heavy 
arterial and cavity injection, with full drainage of blood. 
The vulva should be closed with absorbent cotton. The 
face should be massaged thoroughly toward the heart. 

Senility.— Synonyms. — Old age. 

Definition. — A state of decline in an aged person 
characterized by progressive atrophy of all the tissues and 
organs. 

Pathology. — Excessive shrinking and obliteration 
takes place among the capillaries. The skin becomes 
diminished in thickness. When this occurs, it is easily 
seen why in old age there will follow, after the injection 
of fluid into the arterial system, greenish, brownish, and 
soft spots, in the different parts of the body, especially 
notable in the face neck and hands. The products of de- 
generation may accumulate in the tissues and cause them 
to be thicker than they are in health, as is seen in the 
vessels, the walls of which are much thicker than normal. 
The blood contains fewer corpuscles and solid constituents, 
is more watery, and coagulates more readily; also the 
total quantity is less. The pericardium, endocardium, and 
the capsules of the liver and spleen are opaque and 
toughened. Degeneration of the cardiac substance may 
lead to a state of asthenia, which generally produces 
death. Dilatation of the orifices of the heart may be the 
prominent lesion, or they may be contracted by atheroma, 



362 TREATMENT OF MISCELLANEOUS CASES 

or by thickening of the vales or rings. The lungs are 
changed more or less, increasing the bronchial secretions, 
which during life have been attended by severe par- 
oxysms of coughing. 

Treatment. — Inject half strength fluid for the first 
bottle, following that with $4 strength for the second 
and normal for the third and all thereafter- if more be 
necessary. Blood may be drained from the vein if the 
operator thinks it advisable. The commercial face solu- 
tion or water should be used on the face while massaging 
in order that the skin may be kept moist and to prevent 
dessication from the action of the fluid. The cavity should 
be injected as a matter of precaution. 

Gangrene. — Synonyms. — Senile gangrene ; mortifica- 
tion. 

Definition. — Putrefactive fermentation of dead tissue, 
from various causes. 

Treatment. — The extremities are affected in senile 
gangrene. They should be wrapped with absorbent cot- 
ton which should then be saturated with fluid. The body 
itself should receive the same treatment accorded in 
the paragraph on senility. 



INDEX 



(References are to pages.) 



Abdomen, 101, 254 

Abdominal cavity, 101, 254 

Abdominal fermentation, 182 

Abdominal post, 351 

Absence of normal moisture in 

skin, 200 
Afimentary canal, 96 
Anatomical guides, 225 
Anatomy, 33 
Angiology, 34 
Antemortem staining, 191 
Anus, 112 
Apnea, 157 
Aponeuroses, 55 
Appendix, 109 
Arterial system, 125 
Arteries, structure of, 58 
Artery, differentiated from nerve, 

215 
Artery, differentiated from vein 

215 
Artery, how to cut for injection, 

216 
Artery, how to raise, 214 
Artery, selection of. 211 
Ascending color, 111 
Asphyxia, 157 

Axillary artery, location, 231 
Aztecs embalming, 19 
Azygos system, 125 



Boudet, 22 

Brachial artery, location, 234 
Britain embalming, 18 
Bronchus, 87 



Cadaveric lividity, 168 

Caecum, 109 

Cancerous spots, 190 

Capillary circulation, 132 

Capillary congestion, 204 

Cardia, 104 

Carotid artery, location, 225 

Cartilage, 48 

Cavities, 79 

Cavity embalming, 247 

Cell, 35 

Cerebro-spinal cavity, 79, 247 

Charge of embalming, 222 

Chemical action, 202 

Christian embalming, 20 

Circle of Willis, 127 

Clavicle bone, 77 

Coagulation of blood, 65 

Collateral circulation, 147 

Colon, 111 

Coma, 157 

Cooling of the body, 167 

Coronary circulation, 142 

Cranial cavity, 79, 247 

Cranial evisceration, 351 

Cranial nerves, 81 

Cranium, 94 



Babylonian embalming, 17 

Bandage test, 159 

Belgian embalming, 18 

Bladder, urinary, 118 

Blood, 61 

Blood coagulation, 65 

Blood corpuscles, 63, 64 

Blood plasma, 62 

Blood, removal of, 264 

Blood vascular system 123 

Bones, 48, 69 

Bones of face, 74 

Bones of lower extremity, 77 

Bones of pelvic girdle, 78 

Bones of thorax, 76 

Bones of upper extremity, 77 



D. 

Descending colon, 112 

Descriptive anatomy, 33 

Diaphragm, 99 

Desiccation, 196 

Digestive fermentation, 180 

Direct incision, 257 

Discolorations, 187 

Discolorations after death, 196 

Discolorations before death, 188 

Disinfectants, 221 

Drying action of formaldehyde, 

197 
Duodenum, 107 

363 



364 



INDEX 



(References are to pages.) 



E. 



Ecchymosis, 191 

Egyptian embalming, 5 

Embalming, 153 

Embalming, abdominal cavity, 

254 
Embalming, Aztec, 19 
Embalming, Babylonian, 17 
Embalming, Belgian, 18 
Embalming, Britain, 18 
Embalming, cavity, 247 
Embalming, cerebral cavity, 247 
Embalming, charge, 222 
Embalming, chest cavity, 252 
Embalming, crania cavity, 247 
Embalming, early Christians, 20 
Embalming, Egyptian, 5 
Embalming, Ethiopian, 17 
Embalming, French, 18 
Embalming, Greek, 17 
Embalming, Guanch, 3 
Embalming, Hindoo, 18 
Embalming, Indian, 19 
Embalming, Jewish, 15 
Embalming, later European, 20 
Embalming, Norsemen, 18 
Embalming, Persian, 16 
Embalming, Peruvian, 19 
Embalming, Roman, 17 
Embalming, Scythian, 17 
Embalming, subcutaneous tissue, 

260 
Embalming, thoracic cavity, 252 
Epigastric region, 103 
Esophagus, 99, 250 
Ethiopian embalming, 17 
Ethmoid bone, 74 
European embalming, 20 

F. 

Face bones, 74 
Falcony, 23 
Fascia, 43 
Fat, 56 

Feather test, 159 
Femur bone, 78 
Fermentation, 179 
Fermentation, abdominal, 182 
Fermentation, digestive, 180 
Fermentation, gastric, 184 
Fermentation, intestinal, 185 
Fermentation, metabolic, 181 
Fermentation, putrefactive, 181 
Fermentation, spirituous, 180 
Feverish condition, 199 
Fibula bone. 78 
First call. 205 
Fluid, injection of, 218 
Foetal circulation, 144 
Foramen of Winslow, 121 
Fractures, 194 



Franchini, 22 
Franciolli, 23 
Freezing of the skin, 199 
French embalming, 18 
Frontal bone, 74 

G. 

Gall bladder, 114 

Gangrene, 191 

Gannal, 23 

Gas formation, 179 

Gastric fermentation, 184 

Glands, 47 

Greek embalming, 17 

Greenish tinge of putrefaction, 

200 
Guanch embalming, 3 
Guides, anatomical, 225 
Guides, linear, 225 

H. 

Hair, 41 
Heart, 92 
Heart sac, 92 
Hindoo embalming, 18 
Histology, 33, 35 
Holmes, 25 
Humerus bone, 77 
Hunter, 21 
Hyoid bone, 75 
Hypochondriac re -dan, 'J03 
Hypogastric region, 103 

I. 

Ileum, 108 
Ilium bone, 78 
Indian embalming, 19 
Inferior maxillary bone, 74 
Inferior turbinate bone, 75 
Inguinal region, 103 
Injection of fluid, 218 
Intestinal fermentation, 185 
Intestines, large, 108 
Intestines, 106 
Ischium bone, 78 

J. 

Jejunum, 107 

Jewish embalming, 15 

K. 
Kidneys, 116 

L. 
Lachrymal bone, 75 
Large intestines, 108 
Larynx, 84 
Leucocytes, 64 
Ligaments, 55 
Linear guides, 225 
Liver, 112 



INDEX 



365 



(References are to pages.) 



Lumbar region, 103 

Lungs, 88 

Lymphatic circulation, 123, 147 

Lymphatics, 44 

M. 

Malar bone, 75 

Mediastinum, 91 

Membranes, 57 

Mesentery, 122 

Metabolic, fermentation, 181 

Mirror test, 159 

Modes of death, 155, 156 

Mouth, 97 

Mucous membranes, 57 

Muscles, 54 

Myology, 33 

N 

Nails, 40 

Natural evaporation, 196 

Nerves, 53, 81, 82 

Neurology, 33 

Norse embalming, 18 



North American Indian embalm- £l n V s ? s * ™ 



R. 

Radial artery, location, 237 
Radius bone, 77 
Raising an artery, 214 
Receptaculum chylii, 46 
Rectum, 112 
Regional anatomy, 34 
Removal of blood, 264 
Removal of urine, 263 
Ribs, 76 

Rigor mortis, 177 
Roman embalming, 17 
Ruysch, 21 



Salivary glands, 98 
Sarcolemma, 54 
Scapula bone, 77 
Scars, 194 

Scythian embalming, 17 
Selection of artery, 211 
Serous membranes, 57 
Signs of death, 155, 157 



ing, 19 



O. 



Omentum, 121 
Omohyoid muscle, 75 
Osteology, 33, 69 

P. 

Palate, 97 
Palate bone, 75 
Pancreas, 115 
Parietal bone, 74 
Patella, 78 
Pelvic cavity, 118 
Pericardium, 92 
Peritoneum, 120 
Persian embalming, 16 
Peruvian embalming, 19 
Pharynx, 98 

Pigmentary atrophy, 189 
Pleura, 87 

Plugging orifices, 262 
Portal circulation, 144 



Skeleton, 69 

Skin, 37 

Skin slip, 175 

Skull, 72 

Small intestines, 106 

Sphenoid bone, 74 

Spinal cavity, 81 

Spinal nerves, 82 

Spine, 71 

Spirituous fermentation, 180 

Spleen, 116 

Stomach 103 

Sucquet, 23 

Superior maxillary bone, 7t 

Suprarenal capsule, 117 

Surgical anatomy, 34 

Syndesmology, 33 

Synovial membranes, 57 

Systemic circulation, 125 

Systemic system, 134 

T. 



Position of body on embalming Tattoo marks, 194 



board, 210 
Positive signs of death, 162 
Postmortem discoloration, 203 
Postmortem staining, 204 
Poupart's ligament, 55, 56 
Premature burial, 164 
Prostate, 119 
Protoplasm, 35 
Pubic bone, 78 

Pulmonary circulation, 134, 141 Trachea, 85, 250 
Purging, 249 Transverse colon. 111 

Putrefactive changes, 160 Treatment of accidents, 341 

Putrefactive fermentation, 181 Arm severed, 343 

Pyloris, 104 Body severed, 342 



Teeth, 52, 97 
Temporal bone, 74 
Tendons, 55 
Tests of death, 155, 158 
Thoracic autopsy, 351 
Thoracic cavity, 83, 252 
Thoracic duct, 45 
Tibia bone, 78 
Tissue, 37 



366 



INDEX 



(References are to pages.) 



Broken neck, 341 
Burns, 347 
Chest crushed, 346 
Foot crushed, 345 
Gun shot in abdomen, 347 
Hanging, 341 
Head crushed, 345 
Head severed, 344 
Leg severed, 344 
Scalds 347 
Strangulation, 341 
Treatment of diseases, 285 

Actinomycosis, 293 
Ague, 295 
"Alcoholism, 354 
Anasarca, 339 
Aueurism, 328 
Anthrax, 285 

Aortic incompetency, 321 
Aortic insufficiency, 321 
Aortic regurgitation, 321 
Aortic stenosis, 321 
Appendicitis, 336 
Ar^enicism, 357 
Arterio sclerosis, 325 
Ascites, 337 
Black death, 303 
Black vomit, 296 
Bubonic plague, 303 
Carbuncle, 285 
Carcinoma of liver, 333 
Cardiac atrophy, 324 
Cardiac dilatation, 324 
Cardiac thrombosis, 323 
Cerebro spinal fever, 286 
Cerebro spinal meningitis, 286 
Charbons, 285 
Chicken-pox, 309 
Chills and fever, 295 
Cholera, 302 
Cirrhosis of liver, 333 
Dengue, 294 
Diphtheria, 297 
Dropsy, 337 
Elephantiasis, 359 
Drowned cases, 359 
Endoarteritis, 325 
Endocarditis, 320 
Erysipelas, 287 
Famine fever, 308 
Farcy, 288 
Fatty degeneration of arteries, 

326 
Floater, 359 
Gangrene, 362 
Gangrene of lungs, 312 
Glanders, 288 
Heat stroke, 357 
Hemopericardium. 319 
Hospital fever, 308 
Hydropericardium, 318 



Hydrophobia, 289 

Hydrothorax, 317 

Hypertrophy of heart, 324 

Influenza, 301 

Jail fever, 308 

Jaundice, 329 

Leprosy, 301 

Lockjaw, 292 

Lumpy jaw, 293 

Malaria, 295 

Malignant pustule, 285 

Marsh fever, 295 

Measles, 306 

Mercurialism, 357 

Mitral incompetency, 321 

Mitral insufficiency, 321 

Mitral regurgitation, 321 

Mitral stenosis, 322 

Morphinism, 356 

Mother and unborn child, 360 

Mumps, 307 

Obesity, 358 

Parotitis, 307 

Pericarditis, 318 

Peritonitis, 336 

Pertussis, 308 

Plumbism, 356 

Pneumonia, 314 

Pneumopericardium, 319 

Pulmonary abscess, 314 

Pulmonary hemorrhage, 312 

Pulmonary incompetency, 323 

Pulmonary insufficiency, 323 

Pulmonary stenosis, 323 

Putrid fever, 308 

Pyemia, 311 

Rabies, 289 

Relapsing fever, 290 

Rubeola, 306 

St. Anthony's fire, 287 

Scarlatina, 304 

Scarlet fever, 304 

Scarlet rash, 304 

Senility, 361 

Septicemia, 310 

Ship fever, 308 

Small-pox, 305 

Splenic fever, 285 

Spotted fever, 286 

Swamp fever, 295 

Syphilis, 290 

Tetanus, 292 

Tricuspid incompetency, 322 

Tricuspid regurgitation, 322 

Tuberculosis, 298 

Typhoid fever, 299 

Typhus fever, 308 

Varicella, 309 

Variola. 305 

Whooping cough, 308 

Wool-sorter's disease, 285 

Yellow fever, 296 






INDEX 



367 



(References are to pages.) 



Treatment of posted cases, 351 
Abdominal post, 351 
Cranial evisceration, 351 
Posted cases, 352 
Thoracic autopsy, 351 

Trocar method, 255 

U. 

Ulna bone 77 

Ulnar artery, location, 240 

Umbilical region, 103 

Ureter, 117 

Urinary bladder, 118 

Urine, removal of, 263 

Uterus, 118 



Vasa-vasorum, 60 
Vascular system, 123 
"Veins, structure of, 60, 61 
Venous circulation, 134 
Venous congestion, 204 
Vermiform appendix, 109 
Vertebral column, 71 
Vomer, 75 

W. 

Winslow, Foramen of, 121 
Wounds, 193 

Y. 
Yellow jaundice, 188 



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